Fill and Sign the Form 3 34

F.C.A.§§ 350.2,351.1,352.1 Form 3-34352.2,353.1,353.3, (Juvenile Delinquency-353.5 Order of Disposition After Removal-RestrictivePlacement) 12/2015At a term of the Family Court of the State of New York, held in and for theCounty of at New Yorkon , .PRESENT: Hon. Judge___________________________________In the Matter ofDocket No.ORDER OFDISPOSITIONA Person Alleged to be a(Designated Felony --Juvenile Delinquent,After Order of Removalwith Finding --Restrictive Placement)Respondent.______________________________________An Order of Removal pursuant to section “ 220.10 “ 310.85 “ 330.25 of the CriminalProcedure Law, deemed to be a petition in accordance with section 311.1 of the Family Court Act,having been duly filed with this Court on , , and containing a finding “ upon the above-named Respondent's plea of guilty “ after a juvenile delinquency fact determination “ after a verdict of guilty beyond a reasonable doubt that the Respondent did the following act(s) that would, if committed by an adult, constitute thefollowing crime(s) [specify as to each count]:“ designated felony act(s) pursuant to section 301.2 of the Family Court Act [specify,including section(s) of the Penal Law or other law violated]: “ non-designated felony act(s) [specify, including section(s) of the Penal Law or other lawviolated]: ; and[Check box only if applicable]: “ The above crime included infliction of serious physicalinjury upon a person who is 62 years of age or older. See F.C.A. §355.5(3). ; and Notice having been duly given to Respondent, the Presentment Agency and “ Respondent's Form 3-34 Page 2parent(s) “ person(s) legally responsible for the Respondent’s care pursuant to section 341.2 of theFamily Court Act; andRespondent and counsel for Respondent, and the Presentment Agency having appeared (andof Respondent (not) having appeared) before the Court to answer the petition; andPursuant to section 350.2 of the Family Court Act, the matter having thereafter duly come onfor a dispositional hearing before the Court, the Court, after making an examination and inquiry intothe facts and circumstances of the case and making reports available to counsel in accordance withsection 351.1 of the Family Court Act, finds upon a preponderance of the evidence that the respondentrequires supervision, treatment, or confinement, and more specifically, restrictive placement inaccordance with section 353.5 of the Family Court Act for the following reasons:[Check box only if applicable]: “ The above crime included infliction of serious physical injury upona person who is 62 years of age or older. See F.C.A. §355.5(3).Findings Regarding Pre-dispositional Risk Assessment Instrument:There “ is “ is not a validated pre-dispositional risk assessment instrument in use in this countythat was developed by (or in New York City, approved by) the New York State Office of Children andFamily Services.[REQUIRED where there is a validated pre-dispositional risk assessment instrument in use]:Respondent has been assessed on the risk assessment instrument as a [check box for level of risk]:[NYC cases only]: “ low “ medium “ high “ very high level of risk [NON-NYC cases only]: “ low “ medium “ high level of risk . [REQUIRED where validated pre-dispositional risk assessment instrument is in use and whereRespondent was assessed at a low or moderate level of risk ; omit if inapplicable]:“ Placement, as directed below, is necessary, both for the protection of the community and to beconsistent with the needs and best interests of the Respondent, notwithstanding the assessed risk level,for the following reasons {specifyNOW therefore, upon the Order of Removal and the findings made in the dispositionalhearing, and upon all proceedings had herein, it is herebyORDERED and ADJUDGED that the above-named Respondent is a juvenile delinquentbased on the Order of Removal and on the further ground that the respondent requires supervision,treatment, or confinement; and it is thereforeORDERED that the proceeding is hereby continued, and the Respondent is placed for aperiod of years “ less the period spent in detention pending disposition,1 in the custody of the1 Applicable unless the court finds that all or part of such credit would not serve the needs and best interestsof the respondent or the need for protection of the community. See F.C.A. § 353.5(4). Note: the placement periodmay be tolled by reason of the Respondent’s absence without leave. Form 3-34 Page 3New York State Office of Children and Family Services for confinement in a secure facility for months and may not be released therefrom or transferred to a non-secure facility during the months ofconfinement; and it is furtherORDERED that after the period of confinement in a secure facility, the Respondent shall beplaced in a residential facility for a period of months and may not be released therefrom; and it isfurtherORDERED that the Respondent shall not be discharged from the custody of the New YorkState Office of Children and Family Services during the term of this order; and it is furtherORDERED that the New York State Office of Children and Family Services “shall “ shall not report to the Court pursuant to section 353.5 of the Family Court Act. and it is further ORDERED that [Check applicable box]: “ Respondent’s parent or legal guardian was present in Court and consented to the provision ofroutine medical, dental and mental health services and treatment to the Respondent by the New YorkState Office of Children and Family Services;OR “ Consent has not been obtained from Respondent’s parent or legal guardian, but this Order shallbe deemed to grant consent for the New York State Office of Children and Family to provide routinemedical, dental and mental health services and treatment to the Respondent.[OPTIONAL]: “ ORDERED that the New York State Office of Children and FamilyServices shall photograph the Respondent, pursuant to Executive Law § 507-a (3) ) ; and it is furtherORDERED that [specify]:PURSUANT TO SECTION 1113 OF THE FAMILY COURT ACT, AN APPEAL FROM THISORDER MUST BE TAKEN WITHIN 30 DAYS OF RECEIPT OF THE ORDER BY APPELLANT INCOURT, 35 DAYS FROM THE DATE OF MAILING OF THE ORDER TO APPELLANT BY THECLERK OF COURT, OR 30 DAYS AFTER SERVICE BY A PARTY OR THE ATTORNEY FORTHE CHILD UPON THE APPELLANT, WHICHEVER IS EARLIEST.Dated: , .ENTER_____________________________________Judge of the Family CourtCheck applicable box:“ Order mailed on [specify date(s) and to whom mailed ]:___________________________“ Order received in court on [specify date(s) and to whom given]:_____________________