D.R.L. § 115-c S.C.P.A. § 1725 Form 21-C (Temporary Guardianship) 12/97 COURT OF THE STATE OF NEW YORK COUNTY OF In the Matter of the Temporary Guardianship of A Child Whose First Name is (Docket) (File) No. NOTICE TO: PLEASE TAKE NOTICE that pursuant to section 1725 of the Surrogate's Court Procedure Act and section 661 of the Family Court Act: 1. A petition for adoption must be filed int his Court within 45 days form the date of the signing of the consent to the adoption which has been filed as part of the above-entitled proceeding. 2. Any order or decree of temporary guardianship entered in the above-entitled proceeding will expire no later than nine (9) months following its issuance or upon the entry of a final order of adoption, whichever is sooner, unless, upon application to the court, it is extended for good cause. 3. Any order or decree of temporary guardianship entered int he above-entitled proceeding will terminate upon withdrawal or denial of a petition to adopt the above-named child, unless the court orders a continuation of such order or decree. Dated: , 19 . Clerk of the Court ___________________________________ Petitioner ___________________________________ Print or type name ___________________________________ Signature of Attorney, if any ___________________________________ Attorney's Name (Print or Type) ___________________________________ ___________________________________ ___________________________________ Attorney's Address and Telephone Number 2001 © American LegalNet, Inc.