DRL Art. 5-A Form UCCJEA-10 (Order on Petition to Modify Custody or Visitation Order ­ UCCJEA), 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 ................................................................................... In The Matter of a Proceeding to Modify a Custody Visitation Order under the Uniform Child Custody Jurisdiction and Enforcement Act Petitioner -against- Docket No. FINAL ORDER TEMPORARY ORDER ON PETITION TO MODIFY ORDER OF CUSTODY VISITATION ­ UCCJEA Respondent ....................................................................................... The Petitioner herein having filed a petition on [specify date]: , pursuant to the Uniform Child Custody Jurisdiction and Enforcement Act [Domestic Relations Law Art. 5-A], requesting an order modifying an order of custody visitation of the following minor children [list each child as follows]: Name of Child: Date of Birth: Address1 And Respondent having appeared before this Court, either in person or by telephone, audiovisual or other electronic means, to answer the petition, having been advised by the Court of the right to counsel, and having admitted denied the allegations of the petition; [Applicable where the judgment or order had been entered in conjunction with a New York child protective dispositional or permanency hearing order directing custody with a relative or other non-parent, pursuant to Family Court Act §1055-b or §1089-a; delete if inapplicable]: And since the judgment order was issued in conjunction with the following child protective or permanency proceeding [specify Family Court, county and docket #]: and provided that the following local department of social services [specify]: and the 1 Unless the Court has ordered the address to be kept confidential pursuant to New York State Domestic Relations Law §§76-h(5), 254 or Family Court Act §154-b. . American LegalNet, Inc. www.FormsWorkFlow.com Form UCCJEA-10 Page 2 following attorney for the child(ren)[specify]: must be notified and made parties to any subsequent proceedings for modification of the judgment or order: the department of social services was so notified and did did not appear; and the attorney for the children was so notified and did did not appear; [Required in cases involving Native-American children, where government agency is a party; check if applicable]: And the following having been duly notified [check applicable box(es)]: parent/custodian tribe/nation United States Secretary of the Interior; And the tribe/nation having: appeared and participated as a party; appeared and declined to assume jurisdiction; appeared and requested transfer of jurisdiction; not appeared; [ Applicable to cases where Petitioner is a relative or other non-parent and where hearing on modification petition was consolidated with child protective dispositional or permanency hearing, pursuant to F.C.A. §§1055-b or 1089-a; delete if inapplicable]: This Court finds that: Termination of the order placing or remanding the child(ren) pursuant to Article 10 or 10-A of the Family Court Act will will not not jeopardize the child(ren)'s safety and is is not in the best interests of the child(ren). The child(ren)'s birth mother has has not consented to the award of custody to the Petitioner. If not, the following extraordinary circumstances support Petitioner's standing to seek custody of the child(ren) [specify]: The child's legally-established birth father has has not consented to the award of custody to the Petitioner. If not, the following extraordinary circumstances support Petitioner's standing to seek custody of the child(ren) [specify]: The child has been living with the following foster parent(s)[specify]: for a period in excess of one year, who has/have has/have not consented to the award of custody to the Petitioner. The local department of social services, the petitioner in the related child abuse or neglect permanency proceeding has has not consented to the award of custody to the Petitioner. The attorney for the child(ren) [specify]: child abuse or neglect permanency proceeding the Petitioner. in the related has not consented to the award of custody to has [Check applicable box(es)]: And the Court having searched the statewide registry of orders of protection, the sex offender registry and the Family Court's warrant and child protective records, and having notified the attorneys for the parties and for the child [check if applicable]: and the following self-represented party or parties American LegalNet, Inc. www.FormsWorkFlow.com Form UCCJEA-10 [specify]: of the results of these searches; Page 3 And the Court having considered and relied upon the following results of these searches in making this decision [specify; if no results found, so indicate]: [Applicable to TEMPORARY orders only]: And the Court, having dispensed with the search of the statewide registry of orders of protection, the sex offender registry and the Family Court's warrant and child protective records because these databases had been reviewed within the past 90 days; [Applicable where a party had made an allegation of domestic violence or child abuse; findings must be stated on the record, included in a written decision OR included in this order; check applicable box]: And the Court having explained its findings on alleged domestic violence or child abuse on the record; And the Court having issued a written decision containing its findings on alleged domestic violence or child abuse; And the Court having found that the allegation that [specify party]: had committed domestic violence or child abuse against [specify party or child(ren)]: was was not proven by a preponderance of the evidence, and having considered the effect of such domestic violence or child abuse upon the best interests of the child(ren) and relevant facts and circumstances as follows in making this order [specify how findings, facts and circumstances were factored into this Order]: And the matter having duly come on to be heard before this Court; NOW, after examination and inquiry into the facts and circumstances of the case and after hearing the proofs and testimony offered in relation thereto; it is hereby ADJUDGED that [check applicable box(es)]: 1. This Court has jurisdiction to modify the child custody or visitation order issued by [specify state or other jurisdiction, index or docket number and date]: on the following groun