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Affirmation Regarding Venue Form. This is a New York form and can be use in Adoption Statewide.
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Tags: Affirmation Regarding Venue, 1-E, New York Statewide, Adoption
D.R.L. §113
[This form must be submitted
in cases where the adoption petition was filed before
a judge other than the judge who heard the most recent
Family Court proceeding]
FAMILY COURT OF THE STATE OF NEW YORK
COUNTY OF
.........................................................................................
In the Matter of the Adoption of
A Child Whose First Name Is:
Adoption Form 1-E
(Affirmation Regarding Venue)
(9/2006)
Docket No.
AFFIRMATION
REGARDING VENUE
.....................................................................................
I , [specify name]:
,
duly admitted to practice law in the State of New York, affirm the following:
, an attorney
1. I represent [specify]:
, the prospective adoptive
parents in the above-entitled proceeding regarding the adoption of [specify child’s first name]:
2. Upon information and belief, according to [specify agency having custody or
guardianship of child or other source of information]:
the child was freed for adoption as follows [check applicable box(es)]:
a. The child’s birth mother:
G surrendered her parental rights in a
Gjudicial surrender executed before Judge [specify]:
in Family Court,
[specify county]:
on [specify date]:
in Docket # [specify]:
Gextra-judicial surrender approved by Judge [specify]:
in Family Court,
[specify county]:
on [specify date]:
in Docket # [specify]:
G had her parental rights terminated by order of Judge [specify]:
in Family
Court, [specify county]:
on [specify date]:
in Docket # [specify]:
G is unknown.
G is deceased.
b. The child’s birth father or any other individual entitled to consent to the adoption:
G surrendered his parental rights in a
Gjudicial surrender executed before Judge [specify]:
in Family Court,
[specify county]:
on [specify date]:
in Docket # [specify]:
Gextra-judicial surrender approved by Judge [specify]:
in Family Court,
[specify county]:
on [specify date]:
in Docket # [specify]:
G had his parental rights terminated by order of Judge [specify]:
in Family
Court, [specify county]:
on [specify date]:
in Docket # [specify]:
G is unknown.
G is deceased.
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Adoption Form I-E
Page 2
3. Upon information and belief, according to [specify agency having custody or
guardianship of child or other source of information]:
the child’s most recent permanency hearing was held before [specify judge or referee]
in Family Court, [specify county]:
, on [specify date]:
4. This adoption proceeding has been filed before this Court for the following reasons
[check applicable box(es) and explain]:
G This Court is more familiar with the facts and circumstances regarding permanency
planning for, and the needs and best interests of, this child, because [specify]:
G The child’s law guardian [specify]:
the child in this proceeding.
is able to continue to represent
G The prospective adoptive parents reside in [specify county]
and would find it inconvenient to travel to the Family Court in [specify county]:
G This Court will be able to proceed in this matter more expeditiously because [specify]:
G Other [specify]:
WHEREFORE, for the reasons stated above, I am requesting that this Court retain
jurisdiction over this adoption proceeding.
__________________________________________
Signature of Affirmant
__________________________________________
Affirmant’s Name (print or type)
__________________________________________
__________________________________________
__________________________________________
Affirmant’s Address and Telephone Number
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