Fill and Sign the Order Releasing Agency and Changing Placement 10 16 Form

F.C.A. §1074 Form 10-16(Child Protective - OrderReleasing Agency andChanging Placement) (8/2010) At a term of the Family Court of theState of New York, held in and for the County of ,at New York,on , .Present: Hon. Judge ......................................................................... In the Matter of Docket No. ORDER ON PETITION FORRELEASE OF RESPONSIBILITYCIN #UNDER ORDER OF PLACEMENTA Child Under EighteenAlleged to be GAbused GNeglected by Respondent(s).........................................................................IF YOUR CHILD STAYS IN FOSTER CARE FOR 15 OF THE MOST RECENT22 MONTHS, THE AGENCY MAY BE REQUIRED BY LAW TO FILE APETITION TO TERMINATE YOUR PARENTAL RIGHTS AND MAY FILEBEFORE THE END OF THE 15-MONTH PERIOD. IF SEVERE OR REPEATED ABUSE IS PROVEN BY CLEAR AND CONVINCING EVIDENCE,THIS FINDING MAY CONSTITUTE THE BASIS TO TERMINATE YOURPARENTAL RIGHTS. IF THE PETITION IS GRANTED, YOU MAY LOSEYOUR RIGHTS TO YOUR CHILD AND YOUR CHILD MAY BE ADOPTEDWITHOUT YOUR CONSENT. THE NEXT PERMANENCY HEARING SHALL BE HELD ON [Specify date/time]:1 If the child remains in foster care, the permanency hearing must be scheduled for a date certain, in most 1cases on the previously-scheduled date, not more than eight months from the date of removal of the child from homeor within six months of the last permanency hearing. If this Order grants the agency’s petition for release fromresponsibility and the child is discharged, the previously-scheduled date should be cancelled. If the child is notdischarged, the permanency hearing may be scheduled to coincide with a new dispositional hearing, so long asnotices are given as required by Family Court Act §1089. If the child has been placed and the child has a sibling orhalf-sibling removed from the home, whose permanency hearing is scheduled before this Court, the date certain shallbe the same as the date certain for the sibling’s or half-sibling’s permanency hearing, unless the sibling or half-sibling was removed on a juvenile delinquency or PINS petition or unless he or she has been freed for adoption. Form 10-16 Page 2 An Order, dated , having been made herein placing the above-named child inthe custody of [specify]: , an authorized agency; and apetition, sworn to on , having been filed by the agency for leave toreturn the child to this Court and for the release of the agency from responsibility under the Orderof Placement; and The matter having duly come on to be heard; and the following having appeared [specify]:and good cause therefore having been shown; it is G ORDERED that theauthorized agency is granted leave to return the child to the Court and, upon such return,the agency is released from any further responsibility under the Order of Placement; and itis further G ORDERED that upon the return of the child(ren) to this Court [specify]:ORG ORDERED that the Petition for Release from Responsibility Under Order ofPlacement is DENIED. . ENTER _____________________________________ Judge of the Family Court Dated: 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]:_____________________