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 New York Codes Rules Regulations (Last Updated: March 27,2024)
 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
  Juvenile Delinquency Forms (Family Court Act Article 3)
  3-24 Petition (modification of order of commitment)

  3-24 Petition (modification of order of commitment)  

Sec. 322.1 F.C.A.
 
Form 3-24
 
 
(Juvenile Delinquency)
 
 
7/83
 
FAMILY COURT OF THE STATE OF NEW YORK
 
COUNTY OF _________
________________
In the Matter of
 
Docket No. __
______
 
PETITION
 
(Modification of Order of
A Person Alleged to be a
 
Commitment) Juvenile Delinquent,
______ Respondent.
________________
TO THE FAMILY COURT:
The undersigned (appearing on behalf of the) Petitioner respectfully alleges that:
(1. Petitioner is the (Commissioner of Mental Health) (Commissioner of Mental Retardation and Developmental Disabilities) and pursuant to an order of this Court, dated __, 19 , petitioning Respondent in the above-entitled proceeding has been committed to a residential facility within the appropriate office of the Mental Hygiene Department.)
(1. (S)he is the __ of the petitioning respondent in the above-entitled proceeding and is appearing on behalf of said child for the purpose of filing this petition. Pursuant to an order of this Court dated __, 19 , petitioning Respondent has been committed to a residential facility within the appropriate office of the Mental Health Department.)
2. Petitioner believes that the continued commitment of the above-named child in such residential facility is no longer appropriate in that
 
WHEREFORE, Petitioner requests a hearing for a modification of the order of commitment dated __, 19 , to authorize the transfer of Respondent to a non-residential facility.
Dated: _________, 19.
( Commissioner
By Name
Title )
(By On Behalf of the Petitioner (Child) )
VERIFICATION (Agency)
STATE OF NEW YORK
 
)
 
 
) ss.:
 
COUNTY OF
__
 
)
__, being duly sworn, deposes and says:
That (s)he is the __ of __, an agency authorized to originate the above-entitled proceeding, and is acquainted with the facts and circumstances therein; that (s)he has read the foregoing and knows the contents thereof; that the same is true to (his) (her) own knowledge, except as to matters therein stated to be alleged on information and belief and as to those matters (s)he believes it to be true.
Name
Title
Sworn to before me this
 
__ day of __, 19.
(Notary Public)
VERIFICATION (Individual)
STATE OF NEW YORK
 
)
 
 
) ss.:
 
COUNTY OF
__
 
)
__, being duly sworn, deposes and says:
That (s)he is the __in the above-entitled proceeding and is acquainted with the facts and circumstances thereof; that (s)he has read the foregoing and knows the contents thereof; that the same is true to (his) (her) own knowledge, except as to matters therein stated to be alleged on information and belief and as to those matters (s)he believes it to be true.
 
Sworn to before me this
 
__ day of __, 19.
(Deputy) (Clerk of the Court)
(Notary Public)