10-27 Petition for extension of supervision, 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)

10-27 Petition for extension of supervision

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

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)