Fill and Sign the Child Protective Application for Return Form

F.C.A. §1028Form 10-4 (Child Protective – Application for Returnof Child Temporarily Removed from Home) (9/2006)FAMILY COURT OF THE STATE OF NEW YORKCOUNTY OF------------------------------------------------------------------In the Matter ofDocket No. CIN #Application for Return of Child Temporarily Removed(A) Child(ren) under the Age of Eighteen yearsFrom HomeAlleged to be “Abused “Neglected byRespondent(s)------------------------------------------------------------------TO THE FAMILY COURT:1. I am the “Respondent “ Law Guardian in the above-entitled proceeding.2. The following child(ren)[specify]: (was)(were)temporarily removed from the place where the child(ren) resided on [specify date]:The child(ren) were removed [check box]: “ by order of the Family Court, dated [specify]:“ upon the Respondent’s written consent; “ on an emergency basis without a court order. 3. A petition “has “ has not been filed under Section 1031 of the Family Court Act. 4. No previous application has been made to any court or judge for the relief requestedherein, (except)[specify]:WHEREFORE, I respectfully request a hearing regarding the return of the child(ren).Dated: Respondent____________________________________ Respondent’s Address, Telephone No._____________________________________ Attorney for Respondent_____________________________________ Attorney’s Address, Telephone No. Law Guardian_____________________________________ Law Guardian’s Address, Telephone No.