383-c-4 Order (approving) (disapproving) surrender instrument, Foster Care Forms (Social Services Law Section 383-c), 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

Foster Care Forms (Social Services Law Section 383-c)

383-c-4 Order (approving) (disapproving) surrender instrument

Soc. Serv. Law § 383-c

Form 383-c-4

(Order-Approval or

Disapproval of

Surrender Instrument)

12/97

At a term of the Family Court of the

State of New York, held in and for the

County of

, New York,

, 19

P R E S E N T:

Hon. Judge

________________

In the Matter of the Application for Approval

Docket No.

of a Surrender Instrument concerning

ORDER (APPROVING) (DISAPPROVING) SURRENDER INSTRUMENT (CHILD IN FOSTER CARE)

Pursuant to Section 383-c of the

Social Services Law

________________

The petition of

an authorized agency dated the

day of

, 19

, having been filed requesting Court approval of an instrument of surrender executed on the

day of

, 19

, committing the guardianship of the person and custody of

, a child under the age of eighteen years to

, an authorized agency and

affidavits of two witnesses to the execution of such surrender instrument having been filed with the petition in accordance with Section 383-c(4)(b), and (parents) (guardians) (having been duly served with notice of this proceeding and having (personally) appeared before this Court with (out)(by) counsel, (failed to appear); (and a law guardian having been appointed to represent the child) and

The matter having duly come on for a hearing before this Court, and the Court, after hearing the proof and testimony offered in relation to the case, being satisfied that the (parent(s)) (guardian(s)) executed such instrument knowingly and voluntarily,

Form 383-c-4 Page 2

NOW THEREFORE, it is

ORDERED that the petition herein is hereby (GRANTED) (DENIED), and the instrument dated

, executed by

, is hereby (approved) (disapproved); and it is further

ORDERED that the transfer of custody and guardianship to the Petitioner is hereby approved [Applicable to approved instruments only; delete if inapplicable]; (and it is further

ORDERED that a copy of this Order shall be served (personally) (by certified mail) by the Petitioner upon the (parent(s)) or (guardian(s)) who executed the aforesaid instrument of transfer.

Such service shall be made within

days from the date hereof, together with a notice of the terms and conditions, if any, under which the custody and guardianship of such child may be returned to the (parent(s)) (guardian(s)).

PURSUANT TO SECTION 1113 OF THE FAMILY COURT ACT, AN APPEAL FROM THIS ORDER MUST BE TAKEN WITHIN 30 DAYS OF RECEIPT OF THE ORDER BY APPELLANT IN COURT, 35 DAYS FROM THE DATE OF MAILING OF THE ORDER TO APPELLANT BY THE CLERK OF COURT, OR 30 DAYS AFTER SERVICE BY A PARTY OR THE LAW GUARDIAN UPON THE APPELLANT, WHICHEVER IS EARLIEST.

ENTER

J.F.C.

Dated:

, 19

Check applicable box:

□ Order mailed on [specify date(s) and to whom mailed]:

□ Order received in court on [specify date(s) and to whom given]: