Soc. Serv. Law §358-a(4) Form 358-a-2 Order Directing or Dispensing with Service of Notice 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 the Application for Approval of an Instrument Concerning Docket No. ORDER G DIRECTING G DISPENSING WITH SERVICE OF NOTICE CIN # Pursuant to Section 358-a of the Social Services Law. ____________________________________________ The petition of an authorized official of the G Department of Social Services, County, GNew York City Administration for Children's Services), dated [specify]: having been filed with this Court requesting approval of an instrument transferring custody and care of the child [specify]: to the agency; [Check box, if applicable]: G And the above-mentioned instrument executed by [specify]: , the Gparent(s) G guardian(s) containing consents to the jurisdiction of the Family Court over this proceeding and waivers of service of the petition and notice of proceeding, NOW THEREFORE, it is hereby [check applicable box(es)]: G ORDERED that service of a notice of the proceeding and a copy of the petition shall be made upon [specify]: in the following manner [specify]: American LegalNet, Inc. www.FormsWorkFlow.com Form 358-a(2) Page 2 G ORDERED that service of a notice of this proceeding and a copy of the petition upon the above-named consenting Gparent(s) G guardian(s), shall be dispensed with. 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 OR 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: 9 Order mailed on [specify date(s) and to whom mailed ]:___________________________ 9 Order received in court on [specify date(s) and to whom given]:_____________________ American LegalNet, Inc. www.FormsWorkFlow.com