383-c-5 Order disapproving surrender instrument

    

At a term of the Family Court of the State of New York, held in and for the County of __, at __, New York, on __, 19.

  

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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, not being satisfied that the (parent(s)) (guardian(s)) executed such instrument knowingly and voluntarily,

NOW THEREFORE, it is

ORDERED that the petition herein is hereby DENIED, and the instrument dated __, executed by __, is hereby disapproved; (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)).

Dated: ______, 19.

J.F.C.