Fill and Sign the Ny Disposition Form

F.C.A. §§ 841; 842; 842-a Form 8-5 [Note: If petition is dismissed, use Form 8-7] (Family Offense - Order of Fact-finding and Disposition) (12/2013) At a term of the Family Court of the State of New York, held in and for the County of at , New York, on , . P R E S E N T : Hon. Judge ............................................................... Petitioner, Docket No. -against- ORDER OF FACT-FINDING AND DISPOSITION Respondent. ............................................................... NOTICE: YOUR WILLFUL FAILURE TO OBEY THIS ORDER MAY, AFTER COURT HEARING, RESULT IN YOUR COMMITMENT TO JAIL FOR CONTEMPT OF COURT FOR A TERM NOT TO EXCEED SIX MONTHS FOR EACH VIOLATION. VIOLATIONS OF AN ORDER OF PROTECTION MAY RESULT IN CRIMINAL PROSECUTION AND INCARCERATION FOR UP TO SEVEN YEARS FOR CRIMINAL CONTEMPT. A petition under Article 8 of the Family Court Act having been filed in this Court; and the Petitioner [specify]: having [check applicable box(es)]: appeared with counsel without counsel not appeared ;❑ ❑ ❑ ❑ not appeared but counsel appeared; ❑ and the Respondent [specify]: having [check applicable box(es)]: appeared with counsel without counsel waived counsel not appeared ; ❑ ❑ ❑ ❑ ❑ not appeared after service not appeared but service could not be made after every ❑ ❑ reasonable effort had been made to effect service not appeared but counsel appeared; ❑ and the Respondent [specify]: having: voluntarily, intelligently and knowingly admitted in open court that (s)he committed ❑ the following act(s) [specify]: denied the allegations of the petition and the matter having duly come on for a fact- ❑ finding hearing before this Court ; failed to appear and the matter having duly come on for a fact- finding hearing by ❑ inquest before this Court ; voluntarily, intelligently and knowingly consented to the entry of an order of fact- ❑ finding without admission; And the Court finds that after [check applicable box(es)]: hearing the proofs and ❑ testimony offered in relation to the case accepting the admission by Respondent [specify]: ❑ the following allegations in the petition are supported by a preponderance of the evidence [specify]: and that Respondent committed acts constituting the following family offense(s) [specify]: Disorderly conduct ❒ Menacing in the 2 ❒ nd or 3 rd degree Harassment in the 1 ❒ st or 2 nd degree Reckless endangerment ❒ Assault in the 2 ❒ nd or 3 rd degree Aggravated harassment in the 2 ❒ nd degree Attempted assault in 2 ❒ nd or 3 rd degree Stalking ❒ Criminal mischief ❒ Sexual misconduct ❒ Forcible touching ❒ Sexual abuse in the 2 ❒ nd 1 or 3 rd degree Strangulation ❒ Criminal obstruction of breathing or circulation ❒ Identity theft in 1 ❒ st , 2 nd or 3 rd degree Grand larceny in 3 ❒ rd or 4 th degree Coercion in 2 ❒ nd degree [Penal Law §135.60 (1),(2),or (3)] [Delete if inapplicable]: And the Court further finds the following aggravating circumstances [specify]: And the matter having duly come on for a dispositional hearing , and the Court having made examination and inquiry into the facts and circumstances of the persons involved, IT IS HEREBY [Check applicable box(es)]: ORDERED that the petition is GRANTED; and it is further ORDERED that the Respondent shall for a period not in excess of [check applicable box]: ❑ two years five years other period [specify]: observe the ❑ ❑ ❑ conditions of behavior specified in the Order of Protection entered and annexed to and made a part of this order; and it is further ORDERED that the Respondent surrender any and all firearms owned or possessed, including, ❑ but not limited to, the following [specify]: Such surrender shall take place on or before [specify date/time]: at [specify location]: ; and it is further ORDERED ❑ that the Respondent's license to carry, possess, repair, sell or otherwise dispose of a firearm or firearms, if any, pursuant to Penal Law §400.00, is hereby [check applicable boxes]: 1 Where victim is incapable of consent for reason other than being under age 17 [Penal Law §130.60(1)]. Form 8-5 page 4 suspended; revoked; and the Respondent shall remain ineligible to receive a firearm license ❑ ❑ ❑ during the period of this order; and it is further ORDERED that the Respondent pay restitution in the amount of $ ❑ to [specify]: for the benefit of [specify name(s)]: to begin on [specify date]: at the rate of $ per month and to be paid in full by [specify date]: ; and it is further ORDERED that the Respondent is placed on probation under the supervision of the Probation ❑ Department of County for a period of upon the following terms and conditions [check applicable provisions; See 22 NYCRR §§205.74(a),(b)]: ___ 1. Observe the specified conditions of conduct as set forth in the Order of Protection issued pursuant to Section 842 of the Family Court Act. ___ 2. Remain within the jurisdiction of the Court unless granted permission to leave by the Court or probation officer. ___ 3. Answer all reasonable inquiries by the probation officer and notify the probation officer prior to any change in address or employment. ___ 4. Report to a probation officer as directed by the Court or the probation officer and permit the probation officer to visit your place of residence. ___ 5. Do not have any contact with the following persons [specify]: You must not have any physical, visual, written, telephone, e-mail, fax or other electronic or other contact with such person(s). You must not directly or indirectly cause or encourage anyone else to have such contact with such person(s). ___ 6. Pay for medical or mental health treatment expenses for the following person(s) [specify]: . ___ 7. Pay all court-ordered attorney's fees and disbursements incurred by the following person(s) [specify]: that arise from this Family Offense matter. ___ 8. Cooperate with Department of Social Services and/or child protective workers associated with this Family Offense matter. ___ 9. Obey the order for [check applicable box]: no visitation supervised visitation unsupervised visitation with your children. ❑ ❑ ❑ Court-ordered visitation with your children is permitted as follows: _________________________________________________________________ ___ 10. Surrender any and all firearms owned or possessed by you to the law enforcement agency designated above by the date and time ordered above. ___ 11. Attend, pay for, and satisfactorily participate in a batterer's education program designed to help end violent behavior. You will not be discharged from probation without satisfactory completion as determined by your counselor and probation officer. ___ 12. Participate in available [check applicable box(es)]: medical substance abuse ❑ ❑ ❑ psychiatric evaluation and treatment and remain in a specified program as follows:___________________________________________________________ Form 8-5 page 5 ___ 13. Submit to drug/alcohol (alcosensor/urinanalysis) testing as requested by your probation officer. You must cooperate with drug/alcohol counseling and random testing as deemed necessary by your probation officer. ___ 14. Obey the directions given by the probation officer to insure compliance with the Conditions of Probation. ___ 15. Pay restitution or reparation in the amount of $ to [specify]:______________ for the benefit of the following person(s)[specify]: _____________________ to begin on [specify date] :____________________ at the rate of $ per month and to be paid in full by [specify date]__________ ___ 16. Sign Release of Information. ___ 17. Other: ORDERED that the Judgment against the Respondent be and the same is suspended for a period❑ of [specify]: months upon the following terms and conditions [check applicable provisions; see 22 NYCRR §205.74(a)]: ___ 1. Stay away from the residence of the following person(s) [specify]: . ___ 2. Stay away from the place of employment or place of education attended by the following person(s) [specify]: . ___ 3. Do not have any physical, visual, written, telephone, e-mail, fax or other electronic or other contact with the following person(s) [specify]: ; and do not directly or indirectly cause or encourage anyone else to have such contact with such person(s). ___ 4. Do not repeat the conduct that was adjudicated a family offense at the fact-finding hearing. ___ 5. Cooperate in seeking to obtain and in participating in [check applicable boxes]: evaluation and treatment [specify]: medical psychiatric ❑ ❑ ❑ alcoholism drug abuse other [specify]:__________ ❑ ❑ ❑ employment counseling family counseling child guidance services ❑ ❑ ❑ batterer's educational program designated to help end violent behavior ❑ ____6. Permit information to be obtained by the Court from any person or agency providing evaluation, treatment or services specified in ¶5, above. ___ 7. Allow medical or psychiatric treatment to be furnished to the following person(s) [specify]: ___ 8. Cooperate with the person against whom the family offense was committed, the head of the household, or parent, in maintaining the home or household. ___ 9. Pay restitution or reparation in the amount of $ to [specify]: ____________ for the benefit of the following person(s) [specify]: _______________________ to begin on [specify date]: ___________ at the rate of $ per month and to be paid in full by [specify date] . ___ 10. Other [specify]: And it is further ORDERED that [specify]: ❑ Dated: , . ENTER: _____________________________ Form 8-5 page 6 JUDGE OF THE FAMILY COURT 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]:_____________________ ☐ Order served by police on [specify date]:________________________________________ ☐