Fill and Sign the Fillable Online Nycourts in the Matter of Docket No Name Date of Form

F.C.A. §§301.2(17), 380.1(3) Form 3-47[Applicable to Respondents Placed Pursuant to F.C.A. §353.3(Juvenile Delinquency--with the NYS Office of Children and Family Services or the Notice of Placement)NYC Administration for Children’s Services] 9/2012 FAMILY COURT OF THE STATE OF NEW YORKCOURT OF_____________________________In the Matter of Docket No.Name: Date of Birth: NOTICE OF PLACEMENT A Person Alleged to be a Juvenile Delinquent Respondent. _________________________________TO: Designated Educational Official [Specify]: ____________________________ 1 School District and School [Specify, if available]: PLEASE TAKE NOTICE that _______________________________, the Respondent in the above-entitledproceeding, was adjudicated a juvenile delinquent by this Court and was placed with the [check applicable box]:G New York State Office of Children and Family Services G New York City Administration for Children’s Servicespursuant to Family Court Act §353.3 for a period of [specify duration]: _______________________ on [specifydate]: _______________________. CLERK'S CERTIFICATIONI, , (Deputy) Clerk of the Family Court the State of New York, County, do hereby certify that the above information is an accurate summary of the records of this Court.___________________________________(Deputy) Clerk of the Family CourtNOTICE:THIS NOTICE IS CONFIDENTIAL. IT MUST BE KEPT SEPARATE AND APART FROM THESTUDENT’S SCHOOL RECORDS AND MUST NOT BE APPENDED TO OR INCLUDED IN ANYDOCUMENTATION RELATING TO THE STUDENT. IT MUST BE DESTROYED WHEN THESTUDENT IS NO LONGER ENROLLED IN THE SCHOOL DISTRICT. IT MAY BE ACCESSIBLEONLY TO THE EDUCATIONAL OFFICIAL DESIGNATED BY THE SCHOOL DISTRICTPURSUANT TO FAMILY COURT ACT §301.2 TO RECEIVE SUCH NOTICES OF PLACEMENTAND MAY BE USED SOLELY FOR THE PURPOSES SPECIFIED IN FAMILY COURT ACT§§301.2(17), 380.1. THE DESIGNATED EDUCATIONAL OFFICIAL SHALL HAVE ACCESS SOLELYTO THIS NOTICE AND SHALL NOT HAVE ACCESS TO ANY OTHER OFFICIAL RECORDS ORPAPERS PERTAINING TO THE ADJUDICATION EXCEPT BY ORDER OF THE FAMILY COURT. The Designated Education Official for all public schools in New York City is: Kimberly Suttell, 1Director of Attendance Policy and Planning, Office of School and Youth Development, NYC Department ofEducation, 52 Chambers Street, Room 218, New York, NY 10007; Fax:212-374-5751.