New York Codes, Rules and Regulations › Title 22 - JUDICIARY › Subtitle D - Forms › Chapter IV - Forms of the Family Court of the State of New York and Adoption Forms of the Family Court of the State of New York (cf. s205.7) › Subchapter A - Forms Authorized by Section 205.7 › Foster Care Forms (Social Services Law Section 383-C) › Form 383-c-4 - Order (approving) (disapproving) surrender instrument

Current through Register Vol. 46, No. 28, July
					 10, 2024
Soc.Serv. Law § 383-c Form 383-c-4
(Order-Approval or
Disapproval of
Surrender Instrument)
12/97
At a term of the Family Court of
						the
State of New York, held in and for
						the
County of ,
at, New York,
on, 19.
P R E S E N T:
Hon.
Judge
________
In the Matter of the Application for
						Approval Docket No.
of a Surrender Instrument
						concerning
ORDER (APPROVING)
(DISAPPROVING)
SURRENDER
INSTRUMENT (CHILD
IN FOSTER CARE)
Pursuant to Section 383-c of the
Social Services Law
________
The petition of an authorized agency dated
						the day of, 19, having been filed requesting Court approval of an instrument of
						surrender executed on the day of, 19, committing the guardianship of the person
						and custody of, a child under the age of eighteen years to, an authorized
						agency and affidavits of two witnesses to the execution of such surrender
						instrument having been filed with the petition in accordance with Section
						383-c(4)(b), and
(parents)
(c) . The child (is) (is not) a
						Native-American child subject to the Indian Child Welfare Act of 1978 (
The matter having duly come on for a
						hearing before this Court, and the Court, after hearing the proof and testimony
						offered in relation to the case, being satisfied that the (parent(s))
						(guardian(s)) executed such instrument knowingly and voluntarily,
Form 383-c-4 Page 2
NOW THEREFORE, it is
ORDERED that the petition herein is hereby
						(GRANTED) (DENIED), and the instrument dated, executed by, is hereby (approved)
						(disapproved); and it is further
ORDERED that the transfer of custody and
						guardianship to the Petitioner is hereby approved [Applicable to approved
						instruments only; delete if inapplicable]; (and it is further
ORDERED that a copy of this Order shall be
						served (personally) (by certified mail) by the Petitioner upon the (parent(s))
						or (guardian(s)) who executed the aforesaid instrument of transfer. Such
						service shall be made within days from the date hereof, together with a notice
						of the terms and conditions, if any, under which the custody and guardianship
						of such child may be returned to the (parent(s)) (guardian(s)).
PURSUANT TO SECTION
						1113 OF THE
						FAMILY COURT ACT, AN APPEAL FROM THIS ORDER MUST BE TAKEN WITHIN 30 DAYS OF
						RECEIPT OF THE ORDER BY APPELLANT IN COURT, 35 DAYS FROM THE DATE OF MAILING OF
						THE ORDER TO APPELLANT BY THE CLERK OF COURT, OR 30 DAYS AFTER SERVICE BY A
						PARTY OR THE LAW GUARDIAN UPON THE APPELLANT, WHICHEVER IS EARLIEST.
ENTER
______________
J. F.C.
Dated:, 19.
Check applicable box:
Order mailed on [specify date(s) and to
						whom mailed]:
Order received in court on [specify
						date(s) and to whom given]:____________