Fill and Sign the Order of Disposition Designated Felony Restrictive Form

F.C.A§§ 350.2,351.1,352.1Form 3-33352.2,353.1,353.3,(Juvenile Delinquency-353.5Order of Disposition-Designated Felony-Restrictive Placement) 11/2015At a term of the Family Court of the State of New York, held in and for theCounty of ,at New York on , .P R E S E N T: Hon. Judge_______________________________________In the Matter ofDocket No.ORDER OF DISPOSITION A Person Alleged to be a (Designated Felony;Juvenile Delinquent, Restrictive Placement)Respondent.________________________________________An Order of Fact-finding dated the day of , having beenentered in “ this Court “ the Family Court of County adjudging that theRespondent did the following act(s) that would, if committed by an adult, constitute the followingcrime(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).Findings Regarding Pre-dispositional Risk Assessment Instrument:There “ is “ is not a validated pre-dispositional risk assessment instrument in use in thiscounty that was developed by (or in New York City, approved by) the New York State Office of Form 3-33 Page 2Children and Family 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 andwhere Respondent 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 andto be consistent with the needs and best interests of the Respondent, notwithstanding the assessed risklevel, for the following reasons {specify]: The matter having thereafter duly come on for a dispositional hearing before theCourt, the Court, after ordering a probation investigation and diagnostic assessment in accordancewith section 351.1 of the Family Court Act and making reports available to counsel presenting thepetition and counsel for Respondent in accordance with section 351.1 of the Family Court Act and aftermaking an examination and inquiry into the facts and circumstances of the case finds upon apreponderance of the evidence that the Respondent requires supervision, treatment, or confinement,and more specifically, restrictive placement in accordance with section 353.5 of the Family Court Act,for the following reasons:NOW therefore, upon the findings made in the fact-finding and dispositional hearingsherein and upon all proceedings had herein, it is herebyORDERED and ADJUDGED that the above-named Respondent is a juvenile delinquent onthe further ground that the Respondent requires 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 theNew 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 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 1 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 or protection of the community; F.C.A. §353.5(4). Note: the placement period may betolled by reason of the Respondent’s absence without leave. Form 3-33 Page 3“ 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 theprovision of routine medical, dental and mental health services and treatment to the Respondent by theNew York State Office of Children and Family Services;OR “ Consent has not been obtained from Respondent’s parent or legal guardian, but this Ordershall be deemed to grant consent for the New York State Office of Children and Family to provideroutine medical, 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.; AND IT IS FURTHER ORDERED that .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.ENTER_____________________________________ Judge of the Family Court Dated: , . 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]:_____________________