F.C.A § 1015-a, 1022, 1089 Form 10-2a (Child Protective­Order for Services) (8/2010) 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 ____________________________ In the Matter of Docket No. ORDER FOR SERVICES CIN # A Child(ren) under the Age of Eighteen Years Alleged to be Abused Neglected by Respondent(s) _____________________________ [Check applicable box(es)]: A petition under Article 10 of the Family Court Act having been filed with this Court alleging abuse neglect of the above-named child(ren); and An application having been made for the temporary removal of the child(ren) from home; And it appearing that certain services or assistance will facilitate protection of the child(ren), rehabilitation of the family, and, as appropriate, the discharge of the child(ren) from foster care; NOW, therefore, it is ORDERED that the Commissioner of Social Services of the County of provide arrange for the provision of the following services or assistance: ; (and it is further) ORDERED that the Commissioner of Social Services report to the Court in writing on the implementation of this order as follows [specify frequency or date]: 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]:_____________________ American LegalNet, Inc. www.FormsWorkFlow.com