General Form 16 (Order of Dismissal), 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 ,. PRESENT: Hon. Judge/Support Magistrate _____________________________________ In the Matter of a Proceeding under Article of the Court Family Act Docket No. ORDER OF DISMISSAL Respondent. _____________________________________ A petition under Article of the Family Court Act, sworn to on been filed in this Court alleging that the above-named Respondent , having and the matter having duly come on to be heard before this Court and the following parties having appeared [check applicable box(es)]: G the Petitioner Gwith counsel G without counsel G the Respondent Gwith counsel G without counsel NOW, after examination and inquiry into the facts and circumstances of the case [delete if inapplicable]:(and after hearing the proofs and testimony offered in relation thereto), it is hereby ADJUDGED that the allegations of the petition have not been established; it is therefore ORDERED that the petition herein is dismissed Gwith G without prejudice. IF THIS ORDER IS ENTERED BY A JUDGE, 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, 30 DAYS AFTER SERVICE BY A PARTY OR THE ATTORNEY FOR THE CHILD UPON THE APPELLANT OR 35 DAYS FROM THE DATE OF MAILING OF THE ORDER TO APPELLANT BY THE CLERK OF COURT, WHICHEVER IS EARLIEST. American LegalNet, Inc. www.FormsWorkFlow.com General Form GF-16 Page 2 IF THIS ORDER IS ENTERED BY A SUPPORT MAGISTRATE, SPECIFIC WRITTEN OBJECTIONS TO THIS ORDER MAY BE FILED WITH THIS COURT WITHIN 30 DAYS OF THE DATE THE ORDER WAS RECEIVED IN COURT OR BY PROFESSIONAL SERVICE, OR IF THE ORDER WAS RECEIVED BY MAIL, WITHIN 35 DAYS OF THE MAILING OF THE ORDER. ENTER ___________________________________ Judge of the Family Court/Support Magistrate Dated: , . 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