Fill and Sign the 17 Printable Printable Adoption Papers Forms and Templates

D.R.L. §112 Adoption Form 10-C (Affidavit Regarding Status of Appeal – Agency Adoption)(8/2010) FAMILY COURT OF THE STATE OF NEW YORKCOUNTY OF......................................................................................... In the Matter of the Adoption of Docket No. A Child Whose First Name Is: AFFIDAVIT REGARDING STATUS OF APPEAL1 ..................................................................................... STATE OF NEW YORK ) )ss.: COUNTY OF ) I , [specify name]: , , an attorney duly admitted to practice law in the State of New York, swear the following to be true under the penalties of perjury: 1. I represented [specify authorized agency]: in the following proceeding(s) that resulted in the above-named child being freed for adoption [specify termination of parental rights and/or surrender proceeding(s)]: 2. The parental rights of the child’s birth mother were terminated as a result of [check applicable box(es)]: 9 an order of disposition in a termination of parental rights proceeding, dated [specify]: which was served upon the: 9 attorney for the child 9 counsel for the mother 9 mother, if self-represented; 9 other parties [specify]: [Check box if applicable]: 9 The order was not served upon the mother, because she never appeared in the proceeding. This order has not been reversed, modified or vacated and [check applicable box(es)]: 9 a notice of appeal has not been filed and the time to file a notice 9 has 9has not lapsed. 9 a notice of appeal was filed and: 9 the appeal was dismissed as it was not perfected. 9 the appeal was not perfected and the time to perfect 9 has 9has not lapsed. 9 the appeal was perfected and has been disposed of as follows [specify]: T his fo rm m ust b e filed fo r all agency ad o p tio ns in vo lving child ren freed fo r ad o p tio n b y term inatio n o f 1 p arental rights o r surrend er and sho uld b e co m p lete d b y the atto rney rep resenting the agency in tho se p ro ceed ings. Adoption Form 10-C Page 2 and 9 is 9 is not the subject of any further appeal or proceeding on remand pending in any Court; 9 a surrender of the child, dated [specify]: The surrender has not been revoked or vacated and [check applicable box(es)]: 9 it is not the subject of revocation proceedings. 9 revocation proceedings were brought but were disposed of as follows [specify]: 9 a notice of appeal has not been filed and the time to file a notice 9 has 9has not lapsed. 9 a notice of appeal was filed and: 9 the appeal was dismissed as it was not perfected. 9 the appeal was not perfected and the time to perfect 9 has 9has not lapsed. 9 the appeal was perfected and has been disposed of as follows [specify]: and 9 is 9 is not the subject of any further appeal or proceeding on remand pending in any Court; 3. The parental rights of the child’s birth father or any other individual entitled to consent to the adoption were terminated as a result of [check applicable box(es)]: 9 an order of disposition in a termination of parental rights proceeding, dated [specify]: which was served upon the: 9 attorney for the child 9 counsel for the father 9 father, if self-represented; and 9 other parties [specify]: [Check box if applicable]: 9 The order was not served upon the father because he never appeared in the proceeding. This order has not been reversed, modified or vacated and [check applicable box(es)]: 9 a notice of appeal has not been filed and the time to file a notice 9 has 9has not lapsed. 9 a notice of appeal was filed and: 9 the appeal was dismissed as it was not perfected. 9 the appeal was not perfected and the time to perfect 9 has 9has not lapsed. 9 the appeal was perfected and has been disposed of as follows [specify]: and 9 is 9 is not the subject of any further appeal or proceeding on remand pending in any Court; 9 a surrender of the child, dated [specify]: The surrender has not been revoked or vacated and [check applicable box(es)]: 9 it is not the subject of revocation proceedings. 9 revocation proceedings were brought but were disposed of as follows [specify]: 9 a notice of appeal has not been filed and the time to file a notice 9 has 9has not lapsed. 9 a notice of appeal was filed and: 9 the appeal was dismissed as it was not perfected. Form SURR-3 Page 3 9 the appeal was not perfected and the time to perfect 9 has 9has not lapsed. 9 the appeal was perfected and has been disposed of as follows [specify]: and 9 is 9 is not the subject of any further appeal or proceeding on remand pending in any Court; __________________________________________ Signature of Attorney, if any __________________________________________ Attorney’s Name (print or type) __________________________________________ __________________________________________ __________________________________________ Attorney’s Address and Telephone Number Sworn to before me this day of _______________________ (Deputy) (Clerk of the Court) (Notary Public)