SURR-1 Notice of proceeding for approval of judicial or extra-judicial surrender instrument, Surrender Forms, 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

Surrender Forms

SURR-1 Notice of proceeding for approval of judicial or extra-judicial surrender instrument

S.S.L. §§ 383-c, 384, 384-c

Form SURR-1

(Surrender—Notice of Proceeding for

FAMILY COURT OF THE STATE OF NEW YORK

Approval of Judicial or Extra-judicial

COUNTY OF

Surrender Instrument)

(9/2006)

In the Matter of the Application for Approval

Docket No.

of a Surrender Instrument Pursuant to Sections

383-c or 384 of the Social Services Law Concerning

NOTICE OF PROCEEDING FOR

APPROVAL OF

CIN#

□ JUDICIAL □ EXTRA-JUDICIAL

Child's Name:

SURRENDER INSTRUMENT

Date of Birth:

TO:

PLEASE TAKE NOTICE that the annexed petition requesting approval of an instrument of surrender concerning the above-named child has been presented to the Family Court of the State of New York,

County, located at [specify address]:

and that a hearing on the petition will be held on [specify date and time]:

at which time you will have an opportunity to be heard.

PLEASE TAKE FURTHER NOTICE that you have the right to be represented by a lawyer and, if you are a custodial or non-custodial parent, guardian, grandparent, foster parent or other person having physical or legal custody of the above-named child and the Court finds that you are unable to pay for a lawyer, you have the right to have a lawyer assigned by the Court.

FAILURE TO APPEAR MAY RESULT, WITHOUT FURTHER NOTICE, IN COURT APPROVAL OF THE SURRENDER INSTRUMENT AND TRANSFER OF CUSTODY AND GUARDIANSHIP OF THE CHILD TO A SOCIAL SERVICES OFFICIAL OR AUTHORIZED AGENCY FOR THE PURPOSE OF ADOPTION.

NOTICE TO ADJUDICATED, ACKNOWLEDGED OR IDENTIFIED FATHERS, pursuant to Social Services Law § 384-c: You have a right to appear to present evidence to the Family Court relevant to the best interests of the child. Your failure to appear will be considered a denial of your interest in the child and may result, without further notice, in court approval of the surrender instrument and transfer of custody and guardianship of the child to a social services official or authorized agency for the purposes of adoption.

Dated:

Name of Attorney(s)

Attorney(s) for Petitioner:

Mailing Address

Telephone Number