Fill and Sign the Mhl Article 81 New York State Unified Court System Form

F.C.A.§1062Form 10-11a(Child Protective- MotionTo Terminate Placement)(9/2006)FAMILY COURT OF THE STATE OF NEW YORKCOUNTY OF.......................................................................................In the Matter ofDocket No.CIN #A Child under Eighteen Years ofAge alleged to be “Abused “Neglected byMOTION TOTERMINATE PLACEMENTRespondent(s).......................................................................................TO:PLEASE TAKE NOTICE that upon the annexed affidavit of [specify]:sworn to on the day ofand upon all the proceedings heretofore had herein, a motion will be made at this Court at [specifyaddress]: on [specify date]: , or as soon thereafter as the parties and counsel can be heardfor an Order terminating the placement of the following child [specify]: with [specify]: and for such other and further relief as to the Court may seem just and proper.Dated:Yours, etc. Movant: GParent GAttorney GOther [specify relationship to child]:__________________________________________________Print or type name Address and Telephone No. Signature of Attorney, if any Print or Type Name Address and Telephone No. of Attorney, if any