F.C.A.§§1033-b,1044, 1046, 1051 Form 10-9 (Determination Upon Fact-finding ­ Child Neglect/Abuse) 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. CIN# (A) Child(ren) under Eighteen Years of Age Alleged to be Abused Neglected by DETERMINATION UPON FACT-FINDING Abuse Neglect Severe Abuse Repeated Abuse Respondent(s) __________________________________ NOTICE: IF YOUR CHILD STAYS IN FOSTER CARE FOR 15 OF THE MOST RECENT 22 MONTHS, THE AGENCY MAY BE REQUIRED BY LAW TO FILE A PETITION TO TERMINATE YOUR PARENTAL RIGHTS AND MAY FILE BEFORE THE END OF THE 15-MONTH PERIOD. IF SEVERE OR REPEATED ABUSE IS PROVEN BY CLEAR AND CONVINCING EVIDENCE, THIS FINDING MAY CONSTITUTE THE BASIS TO TERMINATE YOUR PARENTAL RIGHTS. IF THE PETITION IS GRANTED, YOU MAY LOSE YOUR RIGHTS TO YOUR CHILD AND YOUR CHILD MAY BE ADOPTED WITHOUT YOUR CONSENT. THE NEXT COURT DATE IS [specify date/time]: THE PERMANENCY HEARING SHALL BE HELD ON [SPECIFY DATE/TIME]:1 Insert a date, in most cases the previously-scheduled date, not more than eight months from removal of child or date of combined dispositional/permanency hearing, unless the petition is dismissed or the child has not been removed from home in which case no date needs to be set. If the child has been placed and the child has a sibling or half-sibling removed from the home, whose permanency hearing is scheduled before this Court, the date certain shall be the same as the date certain for the sibling's or half-sibling's permanency hearing, unless the sibling or halfAmerican LegalNet, Inc. www.FormsWorkFlow.com 1 Form 10-9 Page 2 The petition of [specify]: under Article 10 of the Family Court Act, sworn to on [specify date]: , having been filed in this Court alleging that the above-named Respondent(s) [check applicable box(es)]: neglected abused severely abused repeatedly abused the above-named child(ren); and Notice having been duly given to the Respondent(s) pursuant to section 1036 or 1037 of the Family Court Act; and [Include separate paragraphs for each Respondent, as necessary]: Respondent [specify]: having: appeared with counsel without counsel waived counsel not appeared after service not appeared but service could not be made after every reasonable effort had been made to effect service; Respondent [specify]: having: appeared with counsel without counsel waived counsel not appeared after service not appeared but service could not be made after every reasonable effort had been made to effect service; And Respondent [specify]: having: voluntarily, intelligently and knowingly admitted in open court that (s)he committed the following act(s) [specify]: denied the allegations of the petition and the matter having duly come on for a factfinding hearing before this Court ; failed to appear and the matter having duly come on for a fact- finding hearing by inquest before this Court ; voluntarily, intelligently and knowingly consented to the entry of an order of factfinding without admission pursuant to Family Court Act §1051(a), and the Petitioner, attorney for the child and all other parties having consented to the entry of such order of fact-finding as well; And Respondent [specify]: having: voluntarily, intelligently and knowingly admitted in open court that (s)he committed the following act(s) [specify]: denied the allegations of the petition and the matter having duly come on for a factfinding hearing before this Court ; failed to appear and the matter having duly come on for a fact- finding hearing by inquest before this Court ; voluntarily, intelligently and knowingly consented to the entry of an order of factfinding without admission pursuant to Family Court Act §1051(a), and the Petitioner, attorney for the child and all other parties having consented to the entry of such order of fact- finding as well; And where the parent(s )of the above-named child(ren) are not the Respondent(s), the parent(s) were: present at the hearing and participated as interested party-intervenor(s); sibling was removed on a juvenile delinquency or PINS petition or unless he or she has been freed for adoption. American LegalNet, Inc. www.FormsWorkFlow.com Form 10-9 Page 3 served with a copy of the petition but did not appear; were not served with a copy of the petition and did not appear; although: every reasonable effort had been made to effect service; And the child(ren) having been represented by (an) attorney(s); And the following other interested party-intervenors were present and participated in the hearing [specify name(s) and relationship(s) to child(ren)]: [Required in cases involving Native-American children; 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; And the Court, after [check box] hearing the proofs and testimony offered in relation to the case accepting the admission by Respondent [specify]: ; and having found [check applicable box(es) and specify act(s) of abuse and/or neglect found, if any]: by a preponderance of the evidence that Respondent [specify]: committed the following acts constituting child neglect child abuse [specify act(s), including name(s) of the child(ren), the Penal Law section, if applicable, and grounds for determination]: by a preponderance of the evidence that Respondent [specify]: committed the following acts constituting child neglect child abuse [specify act(s), including name(s) of the child(ren), the Penal Law section, if applicable, and grounds for determination]: [Applicable only where severe or repeated abuse was alleged and Respondent was so advised]: by clear and convincing evidence that Respondent [specify]: severely repeatedly abused the child(ren) by committing the following acts(s) that may form the basis to terminate parental rights [specify act(s), including the name(s) of the child(ren), the Penal Law section, if applicable; and grounds for determination]: by clear and convincing evidence that Respondent [specify]: severely repeatedly abused the child(ren) by committing the following acts(s) that may form the basis to terminate parental rights [specify act(s), including the name