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 › Child Protective Forms (Family Court Act Article 10) › Form 10-27 - Petition for extension of supervision

Current through Register Vol. 46, No. 28, July
					 10, 2024
F.C.A. §§ 1054, 1057 Form
						10-27
(Child Protective--Petition for
Extension of Supervision)
(9/2006)
FAMILY COURT OF THE STATE OF NEW
						YORK
COUNTY OF
________
In the Matter of
CIN#
A Child Under Eighteen Years of Age to be
						Docket No.
Neglected Abused by PETITION FOR
						EXTENSION
OF SUPERVISION[FN1]
Respondents
________
TO THE FAMILY COURT:
The undersigned Petitioner respectfully
						alleges upon information and belief that:
1. a. Petitioner,, is the
Commissioner of Social Services of
						[specify]: County
an agency duly authorized for the
						placement of children under Article 10 of the
Family Court Act.
b. Petitioner's principal office is
						located at [specify]:, New York.
2. a. By order of this Court, dated
						[specify]:, the above-named child,
who was born on [specify date]:, was found
						to be neglected abused severely abused repeatedly abused by [specify
						Respondent(s)]:
b. An Order of Disposition, dated
						[specify]: ,
placed Respondent [specify]: under the
						supervision of [specify agency]:
until [specify expiration date]:, pursuant
						to Family Court Act § 1057.
released the child to the following parent
						or other person legally responsible [specify]:
under the supervision of [specify agency]:
						until [specify expiration date]:
, pursuant to Family Court Act §
						1054.
c. [Delete if inapplicable]: By order of
						this Court, dated [specify]: ,
this order of supervision was extended for
						a period of ________ months, terminating on [specify]:
Form 10-27 Page 2
d. The child currently resides with
						[specify]:
3. Good cause exists for this Court to
						extend the period of supervision for a period of months,
terminating on [specify date]: for the
						following reason(s) [specify]:
4. No previous application has been made
						to any court or judge for this relief (except [specify; delete if
						inapplicable]:).
WHEREFORE, Petitioner requests that this
						Court conduct a hearing, make a finding of good cause to extend the period of
						supervision, enter an order extending the period of supervision for a period of
						________ months, pursuant to Section [check applicable box]: 1054 1057 of the
						Family Court Act, and grant such other and further relief as the Court deems
						appropriate, including, but not limited to, the following [specify]:
Dated:,.
______________
Petitioner
______________
Print or Type Name
______________
Attorney, if any
______________
Attorney's Name (print or type)
________
________
______________
Attorney's Address and Telephone
						Number
VERIFICATION
STATE OF NEW YORK)
) ss.:
COUNTY OF)
being duly sworn, deposes and says:
That (s)he is
and is acquainted with the facts and
						circumstances of the above-entitled proceeding; that (s)he has read the
						foregoing petition and knows the contents thereof; that the same is true to
						(his)(her) own knowledge except as to those matters therein stated to be
						alleged upon information and belief, and that as to those matters (s)he
						believes it to be true.
______________
Petitioner
Sworn to before me this day of
________
(Deputy) (Clerk of the Court)
(Notary Public)
[FN1] This form should be used only for an
						extension of an order of supervision that had not been issued together with an
						order of placement. If the child was placed, the order of supervision extends
						until the completion of the permanency hearing on the placement and may be
						continued along with the placement.