Fill and Sign the Get the Fca 1062 Form 10 11 Child Protective Petition

F.C.A.§1062Form 10-11 (Child Protective-Petition To Terminate Placement) 2/99 FAMILY COURT OF THE STATE OF NEW YORK COUNTY OF ......................... In the Matter ofDocket A Child under Eighteen Years of Age alleged to be (Abused) (and) (Neglected) byPETITION (Termination of Placement) Respondent(s) ................ NOTICE:PLACEMENT OF YOUR CHILD IN FOSTER CARE MAY RESULT IN YOUR LOSS OF YOUR RIGHTS TO YOUR CHILD. IF YOUR CHILD STAYS IN FOSTER CARE FOR 15 OF THE MOST RECENT 22 MONTHS, THE AGENCY MAY BE REQUIRED BY LAW TO FILE A PETITION TO TERMINATE YOUR PARENTAL RIGHTS AND MAY FILE BEFORE THE END OF THE 15-MONTH PERIOD. TO THE FAMILY COURT: The undersigned Petitioner respectfully alleges (upon information and belief) that: 1. Petitioner is a (parent)(guardian) (interested person acting on behalf of) the above-named child and resides at . 2. Under an Order of Adjudication and Disposition of this Court dated , said child was adjudicated to be (neglected)(abused) and was placed in the custody of for a period of months, terminating on , . Form 10-11 Page 2 3. Custody of said child is still under the control of said 4. Petitioner made application on , for the return of said child, which application was (denied)(not granted) within thirty days from the date the said application was made. 5. Said child should be returned to Petitioner for the following reasons: 6. No previous application has been made to any court or judge for the relief requested herein (except ). 7. The child (is)(is not) a Native-American child subject to the Indian Child Welfare Act of 1978 (25 U.S.C. §§ 1901-1963). WHEREFORE, Petitioner requests that an Order be made herein terminating the placement of said child and returning the child to Petitioner. Dated , . _________________ Petitioner ___________ Print or Type Name ___________ Attorney, if any ___________ Attorney’s Name (print or type) ______________ ______________ _____________ Form 10-11 Page 3 Attorney’s Address and Telephone Number VERIFICATION STATE OF NEW YORK ) )ss.: COUNTY OF) being duly sworn, deposes and says: That (s)he is and is acquainted with the facts and circumstances of the above-entitled proceeding; that (s)he has read the foregoing petition and knows the contents thereof; that the same is true to (his(her) own knowledge except as to those matters therein stated to be alleged upon information and belief, and that as to those matters (s)he believes it to be true. Petitioner Sworn to before me this day of (Deputy)Clerk of the Court Notary Public