Affidavit In Support Of Motion To Terminate Placement
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Affidavit In Support Of Motion To Terminate Placement Form. This is a New York form and can be use in Family Court Statewide.
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Tags: Affidavit In Support Of Motion To Terminate Placement, 10-11b, New York Statewide, Family Court
F.C.A.§1062
Form 10-11b
(Child Protective- Affidavit in
Support of Motion
To Terminate Placement)
(9/2006)
FAMILY COURT OF THE STATE OF NEW YORK
COUNTY OF
.......................................................................................
In the Matter of
Docket No.
CIN #
A Child under Eighteen Years of
Age alleged to be
Abused Neglected by
AFFIDAVIT IN SUPPORT OF
MOTION TO
TERMINATE PLACEMENT
Respondent(s)
.......................................................................................
STATE OF NEW YORK
)
) SS.:
COUNTY OF NEW YORK )
, swears the following to be true under the penalties of perjury:
1. I am the parent other interested person [specify relationship to child]:
of [specify child]:
.
I am making this affidavit in support of the motion to terminate the child’s placement.
2. (Upon information and belief,) the above-named child, was removed from (his)(her) home
on [specify date]:
and was placed in foster care on [specify date]:
, as a result of a proceeding under Article 10 of the Family Court Act. Custody of the child
remains with [specify]:
3. I made a request to [specify social services or agency official]:
child’s placement and return the child to my home on [specify date]:
That request was denied on [specify date]:
not granted within 30 days of my request.
to terminate the
.
4. The child’s placement should be terminated and the child should be returned to my home for
the following reasons [specify]:
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Form 10-11b
Page 2
5. No previous application has been made to any court or judge for this relief (except [specify]:
).
WHEREFORE, I respectfully request that an Order be made herein terminating the placement of
the above-named child, returning the child to my home and granting such other and further relief as the
Court may deem just and proper.
Affiant
Sworn to before me this
day of
,
(Deputy) Clerk of the Court
Notary Public
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