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Fill and Sign the Criminal Law New York State Unified Court Form

Fill and Sign the Criminal Law New York State Unified Court Form

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F.C.A. §§1021, 1024Form 10-1a (Child Protective –Notice of Temporary Removal of Child and Right to Hearing)FAMILY COURT OF THE STATE OF NEW YORK 8/2010COUNTY OF .......................................................................................In the Matter ofCIN # Docket No.(A child)(Children) under the Age ofNOTICEEighteen Years Alleged to be (Temporary Removal of“Abused “Neglected by Child and Right to Hearing)Respondent(s)......................................................................................NOTICE:IF YOUR CHILD STAYS IN FOSTER CARE FOR 15 OF THE MOST RECENT 22MONTHS, THE AGENCY MAY BE REQUIRED BY LAW TO FILE A PETITIONTO TERMINATE YOUR PARENTAL RIGHTS AND MAY FILE BEFORE THEEND OF THE 15-MONTH PERIOD. IF SEVERE OR REPEATED ABUSE ISPROVEN BY CLEAR AND CONVINCING EVIDENCE, THIS FINDING MAYCONSTITUTE THE BASIS TO TERMINATE YOUR PARENTAL RIGHTS. IFTHE PETITION IS GRANTED, YOU MAY LOSE YOUR RIGHTS TO YOURCHILD AND YOUR CHILD MAY BE ADOPTED WITHOUT YOUR CONSENT. PLEASE TAKE NOTICE that the child(ren) named above (has)(have) been temporarily removedfrom (his)(her)(their) home and taken into protective custody to avoid imminent danger to the child(ren)’slife or health [check applicable box]:G upon the written consent of a parent or other person legally responsible [Family Court Act §1021];G on an emergency basis [Family Court Act §1024].CONTACT INFORMATION [insert name, title, agency, address and telephone numbers]:Your child(ren) was/were removed by [specify]:You can find out the date, time and place for you to appear for a hearing on the return of your child(ren)and for information on the filing of the petition in Family Court by calling [specify]:Your child(ren) were or will be taken to the following child care agency [specify]:To arrange visits with your child(ren), you can call [specify]: You have a right to ask the Family Court for the return of your child(ren) and to have a hearingwithin three court days [Family Court Act §1028]. To do so, you must file an application in the FamilyCourt, County [specify address and telephone number of the Family Court]:You have the right to be represented by a lawyer. If you cannot afford a private lawyer, you havethe right to ask the court to assign a lawyer.Date: Name, Title/Agency:Address, Telephone No.:

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