10-11b Affidavit in support of motion to terminate placement, Child Protective Forms (Family Court Act Article 10), Subchapter A. Forms Authorized by Section 205.7, 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), Subtitle D. Forms, TITLE 22. Judiciary, New York Codes Rules Regulations

New York Codes Rules Regulations (Last Updated: March 27,2024)

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)

10-11b Affidavit in support of motion to terminate placement

F.C.A.§ 1062

Form 10-11b

(Child Protective-Affidavit in

Support of Motion

To Terminate Placement)

(9/2006)

FAMILY COURT OF THE STATE OF NEW YORK

COUNTY OF

________________

In the Matter of

Docket No.

CIN #

A Child under Eighteen Years of

Age alleged to be

□ Abused □ Neglected by

AFFIDAVIT IN SUPPORT OF

MOTION TO

TERMINATE PLACEMENT

Respondent(s)

________________

STATE OF NEW YORK

)

) SS.:

COUNTY OF NEW YORK

)

, swears the following to be true under the penalties of perjury:

1. I am the □ parent □ other interested person[specify relationship to child]: of [specify child]: I am making this affidavit in support of the motion to terminate the child's placement.

2. (Upon information and belief,) the above-named child, was removed from (his)(her) home on [specify date]: and was placed in foster care on [specify date]: , as a result of a proceeding under Article 10 of the Family Court Act. Custody of the child remains with [specify]:

3. I made a request to [specify social services or agency official]: to terminate the child's placement and return the child to my home on [specify date]: . That request was □ denied on [specify date]: □ not granted within 30 days of my request.

4. The child's placement should be terminated and the child should be returned to my home for the following reasons [specify]:

Form 10-11b Page 2

5. No previous application has been made to any court or judge for this relief (except [specify]:

WHEREFORE, I respectfully request that an Order be made herein terminating the placement of the above-named child, returning the child to my home and granting such other and further relief as the Court may deem just and proper.

Affiant

Sworn to before me this

day of

(Deputy) Clerk of the Court Notary Public