F.C.A. §§ 841; 842; 842-a [Note: If petition is dismissed, use Form 8-7] Form 8-5 (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 , . PRESENT: Hon. Judge ............................................................... Petitioner, -against- Docket No. 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 factfinding hearing before this Court ; " failed to appear and the matter having duly come on for a fact- finding hearing by inquest before this Court ; American LegalNet, Inc. www.FormsWorkFlow.com Form 8-5 page 2 " voluntarily, intelligently and knowingly consented to the entry of an order of factfinding 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 2nd or 3rd degree st nd " Harassment in the 1 or 2 degree " Reckless endangerment nd rd " Assault in the 2 or 3 degree " Aggravated harassment in the 2nd degree nd rd " Attempted assault in 2 or 3 degree " Stalking " Criminal mischief " Sexual misconduct " Forcible touching " Sexual abuse in the 2nd 1 or 3rd degree " Strangulation " Criminal obstruction of breathing or circulation " Identity theft in 1st, 2nd or 3rd degree " Grand larceny in 3rd or 4th degree " Coercion in 2nd 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)]. American LegalNet, Inc. www.FormsWorkFlow.com Form 8-5 page 3 " suspended; " revoked; and " the Respondent shall remain ineligible to receive a firearm license during the period of this order; and it is further to [specify]: " ORDERED that the Respondent pay restitution in the amount of $ 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. ___ 2. ___ 3. ___ 4. ___ 5. Observe the specified conditions of conduct as set forth in the Order of Protection issued pursuant to Section 842 of the Family Court Act. Remain within the jurisdiction of the Court unless granted permission to leave by the Court or probation officer. Answer all reasonable inquiries by the probation officer and notify the probation officer prior to any change in address or employment. 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. 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). Pay for medical or mental health treatment expenses for the following person(s) [specify]: . Pay all court-ordered attorney's fees and disbursements incurred by the following person(s) [specify]: that arise from this Family Offense matter. Cooperate with Department of Social Services and/or child protective workers associated with this Family Offense matter. 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: _________________________________________________________________ Surrender any and all firearms owned or possessed by you to the law enforcement agency designated above by the date and time ordered above. Attend, pay for, and satisfactorily participate in a batterer's education program designed to help end violent beh