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New York Codes Rules Regulations (Last Updated: March 27,2024) |
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TITLE 22. Judiciary |
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Subtitle D. Forms |
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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) |
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Subchapter A. Forms Authorized by Section 205.7 |
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Foster Care Forms (Social Services Law Section 383-c) |
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383-c-1 Petition for approval of surrender, instrument, child in foster care |
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Soc. Serv. Law § 383-c Form 383-c-1 (Petition for Approval of Surrender Instrument, Child in Foster Care) 12/97 FAMILY COURT OF THE STATE OF NEW YORK COUNTY OF ________________ In the Matter of the Application for (Docket) (File) No. Approval of a Surrender Instrument Concerning PETITION FOR Pursuant to Section 383-c of the Social APPROVAL Services Law. OF SURRENDER INSTRUMENT (CHILD IN FOSTER CARE) ________________ TO THE FAMILY COURT OF THE COUNTY OF : The undersigned Petitioner respectfully alleges that: 1. Petitioner is an authorized agency having its office and place of business at in the County of , State of New York. 2(a). , is a (fe)male child under the age of eighteen years, born on at who now resides in the County of , State of New York. 2(b). The subject child (is) (is not) a Native American child subject to the meaning of the Indian Child Welfare Act of 1978 (25 U.S.C. §§ 1901-1963). 3. The child is now in the custody of the petitioner and resides at 4. The guardianship of the person and custody of the child have been committed to the petitioner by a written instrument of surrender, signed by Form 383-c-1 Page 2 ( , mother and , father of the child). ( , (mother) (father) of the child, (father) (mother) being deceased). ( , (mother) (father) of the child, (father) (mother) having abandoned the child for a period of six months immediately preceding the filing of this petition. ( mother of such child, who was born out of wedlock and by father of such child whose consent is required pursuant to Section III of the Domestic Relations Law) ( , guardian of the person of such child lawfully appointed by the) Court of County, State of ) ( ) (both parents of such child being dead (said child being born of of wedlock and the mother of such child being deceased) with the approval of the ( Court) ( ) herewith attached and made a part hereof) in accordance with Section 383-c of the Social Services Law; a copy of the instrument of surrender being attached hereto and made a part hereof. 5. The instrument of surrender was executed and acknowledged before and , whose affidavits are attached herewith and made a part hereof. 6. The names and last known addresses of the child' s parents and all persons required to be given notice of this proceeding are: Form 383-c-1 page 3 Name Address Relationship and there are no persons other than those set forth above entitled to notice pursuant to Section 384-c of the Social Services Law. 7. No previous application has been made for the approval of this instrument of surrender to any court of judge ( except ). WHEREFORE, petitioner prays that this Court enter an order approving such instrument on such notice to such persons as the Court may in its discretion provide Petitioner Print or type name Signature of Attorney, if any Attorney's Name (Print or Type) ______________ ______________ Attorney's Address and Telephone # Form 383-c-1 page 4 VERIFICATION IN PROCEEDING BY AUTHORIZED AGENCY 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 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 , 19 . (Deputy) Clerk of the Court Notary Public |