F.C.A.§§ 777, 778 Form 7-17 (Person in Need of Supervision--Order on Violation of Order of Placement Disposition) 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 (Violation of Order of Placement Disposition) A Person Alleged to be a Person In Need of Supervision, Respondent. ______________________________ The above-named Respondent having been adjudicated by this Court to be a person in need of supervision as defined in Article 7 of the Family Court Act; and an Order of Fact-finding and Disposition having been made, dated , placing the Respondent in the custody of [specify]: The Court, after hearing, being satisfied by competent proof that the Respondent, [check applicable box]: did did not willfully and without just cause fail to comply with the terms and conditions of the placement in that: [specify provisions of order violated and nature of violations]: [Required where Order of Disposition is revoked]: The Court, having determined that the Order of Disposition should be revoked and having fully considered the matter of a new disposition pursuant to Family Court Act §§ 754, 777 and 778, finds and determines that the Respondent requires the following disposition for the following reasons [specify]: Required Findings in Cases in Which the Respondent is Placed: American LegalNet, Inc. www.FormsWorkFlow.com Form 7-17 Page 2 [The following determinations are required when order is placement; check applicable boxes and provide case-specific reasons in A, B and, if applicable, C and D]: And the Court finds and determines that: A. Best Interests Finding: Continuation in, or return to, the Respondent's home would would not be contrary to Respondent's best interests based upon the following facts and for the following reasons [specify]: This determination is based upon the following specific documents and evidence: Report of placement or other agency [specify]: , dated [specify]: Probation Department report, dated [specify]: Mental health evaluation, dated [specify]: Testimony of [specify]: Other [specify]: B. Reasonable Efforts Findings: 1. Reasonable efforts, where appropriate, to prevent or eliminate the need for removal of the Respondent from the home, and, if the Respondent was removed prior to the date of the hearing, to return the Respondent safely to his or her home: were made as follows [specify]: were not made but the lack of efforts was appropriate [check all applicable boxes]: because of a prior judicial finding pursuant to Family Court Act §754(2) that the authorized agency was not required to make reasonable efforts to reunify the Respondent with the parent(s) person(s) legally responsible for Respondent's care [specify date of finding]: because of other reasons [specify]: were not made. This determination is based upon the following specific documents and evidence: Report of placement or other agency [specify]: , dated [specify]: Probation Department report, dated [specify]: Mental health evaluation, dated [specify]: Testimony of [specify]: Other [specify]: 2. [Applicable in cases in which the Respondent's permanency plan is adoption, guardianship or permanent living arrangement other than reunification]: American LegalNet, Inc. www.FormsWorkFlow.com Form 7-17 Page 3 Reasonable efforts to make and finalize the Respondent's permanency plan of [specify]: have been made as follows [specify reasonable efforts, including specific documents or evidence supporting findings]: were not made based upon the following facts and for the following reasons [specify]: This determination is based upon the following specific documents and evidence: , dated [specify]: Report of placement or other agency [specify]: Probation Department report, dated [specify]: Mental health evaluation, dated [specify]: Testimony of [specify]: Other [specify]: C. Special Circumstances Finding [Required where Respondent is 16 or older and is placed]: The following special circumstances warrant placement of the Respondent [specify]: D. Transitional Services Finding [Required where Respondent is 16 or older]: The services needed, if any, to assist the Respondent to make the transition from foster care to independent living are [specify]: NOW, therefore, it is hereby ORDERED, that the Order of Disposition is vacated ORDERED that [check applicable boxes]: Respondent is discharged with a warning. Judgment herein is suspended for a period of [specify]: terms and conditions [specify]:1 months upon the following continued; (and it is further) Respondent is placed on probation under the supervision of the Probation Department of the County of [specify]: for a period of [specify]: upon the following terms and conditions:2 1 2 See 22 NYCRR §205.66(a), attached as Appendix A. See 22 NYCRR§205.66(b), attached as Appendix B. American LegalNet, Inc. www.FormsWorkFlow.com Form 7-17 Page 4 The probation service shall report to the court orally in writing on [specify date]: and every ___ days thereafter concerning Respondent's compliance with the terms and conditions of this order. This proceeding is continued and the Respondent is placed for a period of [specify]: (less the period spent in detention pending disposition)3 in the custody of [specify suitable relative or other person]: , subject to the further orders of this Court. This proceeding is continued and Respondent is placed for a period of [specify period up to 12 months]: (less the period spent in detention pending disposition,)4 in the custody of the Commissioner of Social Services of the County of [specify]: . The position of the Commissioner of Social Services of the County of [specify]: having been considered by the Court, this proceeding is continued and Respondent is placed for a period of [specify period up to 12 months]: (less the period spent in detention pending 5 disposition,) in the custody of the Commissioner of Social Services of the County of [specify]: , for placement with [specify:] , subject to the further orders of this Court. In the event that the Commissioner of Social Services is unable to so place the child, the Commissioner [check applicable box]: shall need not apply to the Court for an order to stay, modify, set aside or vacate the order pursuant to Family Court Act § 762. shall need not return Respondent to this Court for a new dispositional hearing. [Required in all cases where child is