Fill and Sign the Ssl383 C 384 384 C Form Surr 2 Order Directing

S.S.L. §§ 383-c, 384, 384-c Form SURR-2 (Order Directing Service in Proceeding for Approval of Judicial or Extra-judicial Surrender Instrument) (8/2010) At a term of the Family Court of the State of New York, held in and for the County of , at New Yorkon ,. P R E S E N T: Hon. Judge ___________________________________________ In the Matter of the Application for Approval Docket No. of a Surrender Instrument Pursuant to Section 383-c ORDER DIRECTING SERVICE or 384 of the Social Services Law IN PROCEEDING FOR APPROVAL OFConcerning ❒ JUDICIAL ❒ EXTRA-JUDICIAL SURRENDER INSTRUMENT CIN#Child’s Name: Date of Birth: ____________________________________________ A petition, pursuant to section 383-c or 384 of the Social Services Law, requesting approval of an instrument of surrender, dated [specify]: , concerning the above-named child having been filed with this Court, and it appearing that notice should be given to the following person(s) named below, it is hereby ORDERED that notice of the hearing, together with a copy of the petition filed in this Court, shall be served [specify]: ❒ personally ❒by registered mail ❒by certified mail, return receipt requested ❒ other [specify]: upon the following person(s) at least 20 days before the date set for the hearing: _______________________________________________________________________________ _______________________________________________________________________________ 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 FORM 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. Dated: , ENTER ____________________________________ Judge of the Family Court 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]:_____________________