New York FCA 661 SCPA 1707 Form

Order Appointing Guardian of the Person or Permanent Guardian

At a term of the Family Court of the State of New York,

held in and for the County of ,

at , New York, on

a Person Under the Age of 21

Upon reading and filing the petition, duly verified on

for the appointment of the guardian of the person permanent guardian of the , applying

above-named person under the age of 21;

[Delete if inapplicable] And where the subject of the petition is years of age or

older, he/she having consented to the appointment of the guardian;

And where the subject of the petition is over 14 but less than

years of age, the child having expressed a preference for the appointment of the guardian;

And this Court having determined that the best interests of the subject of the petition

will be promoted by the appointment of a guardian of the person permanent guardian, and

that [specify guardian]: is in all respects competent to act as such guardian and

to raise the subject of the proceeding to adulthood;

[Applicable to cases where Petitioner is a relative or other non-parent and where hearing

was consolidated with child protective dispositional or permanency hearing, pursuant to

F.C.A. §§1055-b or 1089-a; delete if inapplicable]:

And this Court having determined that:

Termination of the order placing or remanding the child(ren) pursuant to Article 10 or

10-A of the Family Court Act will will not jeopardize the child(ren)'s safety and is

is not in the best interests of the child(ren).

Form 6-5 Page 2

The child(ren)'s birth mother has has not consented to the award of

guardianship to the Petitioner. If not, the following extraordinary circumstances support

Petitioner's standing to seek guardianship of the child(ren) [specify]:

The child's legally-established birth father has has not consented to the award

of guardianship to the Petitioner. If not, the following extraordinary circumstances support

Petitioner's standing to seek guardianship of the child(ren) [specify]:

The child has been living with the following foster parent(s)[specify]:

for a period in excess of one year, who has/have has/have not consented to the award of

guardianship to the Petitioner.

The local department of social services, the petitioner in the related child abuse or

neglect permanency proceeding has has not consented to the award of guardianship to

the Petitioner.

The attorney for the child(ren) [specify]: in the related

child abuse or neglect permanency proceeding has has not consented to the award

of guardianship to the Petitioner.

IT IS HEREBY ORDERED that [specify guardian]:

upon taking the official oath and filing the designation as required by law, is appointed

guardian of the person permanent guardian of [specify name of subject of the petition]:

child upon the following terms and conditions [specify]:

and that Letters of Guardianship shall issue to the Guardian accordingly; and it is further

ORDERED that, unless terminated by the Court, the appointment shall last until the

subject's [check applicable box]:

18th birthday, unless the Court approves an application for an extension of the

appointment until the age of 21 upon the consent of the subject if the subject is over 18;

OR

21st birthday, since the subject is over 18 and has consented to the appointment until

he/she reaches the age of 21;

[Applicable to cases where hearing was consolidated with child protective dispositional

or permanency hearing, pursuant to F.C.A. §§1055-b or 1089-a; delete if inapplicable]:

ORDERED that the following local department of social services [specify]:

and the following attorney for the child(ren)[specify]: shall

be notified and shall be made parties to any subsequent proceedings for modification,

enforcement or termination of the Order;

Form 6-5 Page 3

AND IT IS FURTHER ORDERED that [specify]:

Dated:

PURSUANT TO SECTION 1113 OF THE FAMILY COURT ACT, AN APPEAL

FROM THIS ORDER MUST BE TAKEN WITHIN 30 DAYS OF RECEIPT OF THE

ORDER BY APPELLANT IN COURT, 35 DAYS FROM THE DATE OF MAILING

OF THE ORDER TO APPELLANT BY THE CLERK OF COURT, OR 30 DAYS

AFTER SERVICE BY A PARTY OR THE ATTORNEY FOR THE CHILD UPON

THE APPELLANT, WHICHEVER IS EARLIEST.

Check applicable box:

Order mailed on [specify date(s) and to whom mailed ]:

Order received in court on [specify date(s) and to whom given]: