Fill and Sign the Affidavit in Support of Motion for Order of Violation of Form

F.C.A.§§1071, 1072Form 10-13a(Child Protective- Affidavit inSupport of Motion for an Order ofViolation of Order of Disposition)(9/2006)FAMILY COURT OF THE STATE OF NEW YORKCOUNTY OF.......................................................................................In the Matter ofDocket No.CIN #:A Child under Eighteen Years ofAge alleged to be AFFIDAVIT IN SUPPORT “Abused “Neglected byOF MOTION FOR ORDEROF VIOLATION OFORDER OFDISPOSITIONRespondent(s).......................................................................................STATE OF NEW YORK ) ) SS.:COUNTY OF NEW YORK ), [check if applicable]: G an attorney duly admitted to practice lawin the State of New York, G swears G affirms the following to be true under the penalties ofperjury:1. I am [state title/position]: , the Petitioner in the above-entitled action. I am making this affidavit in support of the motion for an Order regarding aviolation of the Order of Disposition in the above-entitled case. 2. On [specify date]: , the above-named child(ren) (was)(were) adjudicated to be [check applicable box(es)]: G neglected G abused G severely abused G repeatedly abused within the meaning of Article 10 of the Family Court Act. 3. An Order of Disposition was issued by this Court, dated [specify]: requiring the following Respondent(s) [specify]: to comply with the terms andconditions of an Order of [check applicable box(es)]:G Suspended Judgment G Protection G Supervision G Placement. 4. Under the terms of the Order, the following terms and conditions were imposed upon Form 10-13a Page 2[specify Respondent(s)]: , the G parent(s) G person(s) legally responsible for the care of the child(ren) [specify]:.5. (Upon information and belief) The following Respondent(s) [specify]: willfully and without just cause, violated the terms and provisions of the Order in that [specifyprovision(s) of order violated and nature of violation]:.6. [Required if removal has occurred or is requested; check applicable box(es)]: a. G (Upon information and belief) On [specify date]: , thefollowing child(ren)[specify]: were temporarily removed from thecare of the following Respondent(s) [specify]: on the basis of thefollowing facts and for the following reasons [specify]:in accordance with [check applicable box]: G a court order pursuant to Family Court Act §1027, issued on [specify]: G consent of the following Respondent(s) [specify]: obtained on [specify date]: pursuant to Family Court Act §1021. G on an emergency basis without a court order pursuant to Family Court Act §1024. There was no time to obtain a court order because [specify]: b. G (Upon information and belief) The child(ren) should be removed from thecare of the following Respondent(s) [specify]: in accordance with Family Court Act §1027 in order to prevent imminent risk to the child(ren)’s life or health on thebasis of the following facts and for the following reasons [specify]: c. G The Order of Disposition should be modified as follows [specify, includingwhether placement of child(ren) is requested]:in the child’s best interests in accordance with Family Court Act §1052 on the basis of thefollowing facts and for the following reasons [specify]: 7. [Required if removal or continued removal of children is requested]:a. Continuation in, or return to, the child(ren)'s home would be contrary to the bestinterests of the child(ren) because [specify facts and reasons]:This assertion is based upon the following information [check applicable box(es)]:G Report of Suspected Child Abuse or NeglectG Case Record, dated [specify]:G Service Plan, dated [specify]:G The report of [specify]: , dated [specify]:G Other [specify]: Form 10-13a Page 3b. Reasonable efforts, where appropriate, to prevent or eliminate the need forremoval of the child(ren) from the home [check applicable box and state reasons as indicated]: G were made as follows [specify]: G were not made but the lack of efforts was appropriate [check all applicable boxes]:G because of a prior judicial finding that the Petitioner was not required to makereasonable efforts to reunify the child(ren) with the Respondent(s) [specify dateof finding]: G because [specify other reason(s)]: G were not made. This assertion is based upon the following information [check applicable box(es)]:G Report of Suspected Child Abuse or NeglectG Case Record, dated [specify]:G Service Plan, dated [specify]:G The report of [specify]: , dated [specify]:G Other [specify]:c. Based upon Petitioner’s investigation [Check applicable box(es]:“ The following person [specify]: is a “ non-respondent parent “ relative “ suitable person with whom the child(ren) may appropriately reside [specify]:[Applicable to relatives and other suitable persons]: Such person: “ seeks approval as a foster parent in order to provide care for the child(ren); “ wishes to provide care and custody for the child(ren) without foster care subsidy during the pendency of any order herein. “ may be a resource but not yet determined whether as foster parent or custodian.“ (Upon information and belief) There is no non-respondent parent, relative or suitableperson with whom the child(ren) may appropriately reside.d. (Upon information and belief) Imminent risk to the child(ren) “ would “ would not be eliminated by the issuance of a temporary order of protection or order of protection directing the removal of [specify]: from the child(ren)'s residence,based upon the following facts and for the following reasons [specify]:8.The subject child “ is “ is not a Native-American child, who is subject to the IndianChild Welfare Act of 1978 (25 U.S.C. §§ 1901-1963). If so, the following have been notified[check applicable box(es)]: “ parent/custodian [specify name and give notification date]: “ tribe/nation [specify name and give notification date]: Form 10-13a Page 4 “ United States Secretary of the Interior [give notification date]:9. No previous application has been made to any court or judge for the relief hereinrequested (except [specify]:WHEREFORE, I respectfully request that the Order of [check applicable box(es)]:G Suspended Judgment G Protection G Supervision G Placement be revoked andthat the Court make such other disposition under Article 10 of the Family Court Act as it maydeem proper.Dated , .______________________________________Affiant______________________________________Print or Type NameSworn to before me this day of , (Deputy) Clerk of the CourtNotary Public _____________________________________ Signature of Attorney, if any______________________________________ Attorney’s Name (print or type)__________________________________________________________________________________________________________________ Attorney’s Address and Telephone Number