F.C.A.§§1033-b,1044, 1046, 1051 Form 10-9 (Determination Upon Fact-finding – Child Neglect/Abuse) (9/2006) 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 IS PLACED IN FOSTER CARE, YOU MAY LOSE YOUR RIGHTS TO YOUR CHILD AND YOUR CHILD MAY BE ADOPTED WITHOUT YOUR CONSENT. 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. THE NEXT COURT DATE IS [specify date/time]: THE PERMANENCY HEARING SHALL BE HELD ON [SPECIFY DATE/TIME]:1 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 halfsibling 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 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, Law Guardian and all other parties having consented to the entry of such order of factfinding 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, Law Guardian and all other parties having consented to the entry of such order of factfinding 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); “ served with a copy of the petition but did not appear; American LegalNet, Inc. www.FormsWorkflow.com Form 10-9 Page 3 “ 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 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(s) of the child(ren), the Penal Law section, if applicable; and grounds for determination]: [Required findings in cases where the child(ren), who had NOT been ordered removed earlier in the case, is/are ordered removed pending final disposition; otherwise, skip I and II]: The Court finds and determines that: I. Required “Best Interests” and “Reasonable Efforts” Findings for Newly-removed Children [check applicable boxes and provide case-specific reasons in both A and B, below]: A. Continuation of the child(ren) in, or return of the child(ren) to, the child(ren)'s home American LegalNet, Inc. www.FormsWorkflow.com Form 10-9 Page 4 “ would “ would not be contrary to the best interests of the child(ren) because [specify facts and reasons]: This determination is based upon the following information [check applicable box(es)]: G Petition G Report of Suspected Child Abuse or Neglect G Case Record, dated [specify]: G Service Plan, dated [specify]: G The report of [specify]: , dated [specify]: G Testimony of [specify]: G Other [specify]: B. Reasonable efforts, where appropriate, to prevent or eliminate the need for removal of the child(ren) from the home, and, if the child(ren) were removed without court order prior to the date of this hearing, to return them home safely [check applicable box and state reasons as indicated]: G were made as follows [specify]: G were not made but the lack of efforts was appropriate because of a judicial finding that the Petitioner was not required to make reasonable efforts to reunify the child(ren) with the Respondent(s) [specify date of finding]: G were not made. This determination is based upon the following information [check applicable box(es)]: G Petition G Report of Suspected Child Abuse or Neglect G Case Record, dated [specify]: G Service Plan, dated [specify]: G The report of [specify]: , dated [specify]: G Testimony of [specify]: G Other [specify]: II. Findings Regarding Alternatives to Removal to Foster Care: A. Based upon the investigation conducted by the Commissioner of Social Service, [Check applicable box(es]: “ The following person [specify]: is a “ non-respondent parent “ relative “ suitable person with whom the child(ren) may appropriately reside [specify]: [Applicable to relatives and other suitable persons]: Such person: “ seeks approval as a foster parent in order to provide care for the child(ren); “ wishes to provide care and custody for the child(ren) without foster care subsidy during the pendency of any order herein. “ may be a resource but not yet determined whether as a foster parent or custodian. American LegalNet, Inc. www.FormsWorkflow.com Form 10-9 Page 5 “ There is no non-respondent parent, relative or suitable person with whom the child(ren) may appropriately reside. B. [Required]: Imminent risk to the child(ren) “ would “ would not be eliminated by the issuance of a temporary order of protection or order of protection directing the removal of [specify]: from the child(ren)'s residence. NOW, therefore, upon the findings made in the fact-finding hearing and upon all the proceedings had herein, it is ADJUDGED that facts sufficient to sustain the petition herein “ have “ have not been established, in that [specify]: ; and it is hereby [Check applicable box(es); include separate paragraphs for each child as necessary]: “ ADJUDGED that the above-named child(ren) (is) (are) (a) “ neglected “ abused “ severely abused “ repeatedly abused) child(ren) as defined in section 1012 of the Family Court Act by [specify Respondent(s)]: ; OR “ ORDERED, that the petition filed herein be DISMISSED; and it is further “ ORDERED that the child(ren) shall be temporarily removed from the place where the child(ren) (is) (are) residing by any peace officer or agent of a duly authorized agency, society or institution and that the child(ren) shall be brought to [specify]: pending disposition of this proceeding; (and it is further) “ ORDERED that the child(ren)(is)(are) released to the custody of [specify]: the child(ren)'s “ Respondent parent(s) “ Non-respondent parent(s) “ other person legally responsible for the child(ren)'s care, such release to be under the supervision of [specify, if applicable]: ; (and it is further) , “ ORDERED that, pending further proceedings, the child(ren) shall be placed in the temporary custody of [check applicable box]: “ the Commissioner of Social Services of County; “ the Commissioner of Social Services of County to reside with [specify]: “ the following non-respondent parent(s), relatives or other suitable person(s)[specify]: ; (and it is further) (and it is further) “ ORDERED that the Commissioner of Social Services shall investigate whether there are any non-respondent parents, grandparents, other relatives or other suitable person(s) with whom the child(ren) may appropriately reside, including, but not limited to [specify]: ; shall inform them of the pendency of the proceeding; shall ascertain whether such person(s) wish to seek approval as foster parent(s) in order to provide care for the child(ren) or wish American LegalNet, Inc. www.FormsWorkflow.com Form 10-9 Page 6 to provide care and custody for the child(ren) without foster care subsidy during the pendency of any order herein; and shall record the results of such investigation in the child’s Uniform Case Record; (and it is further) “ ORDERED that, within 24 hours of this order, the Commissioner of Social Services shall commence an investigation of the following relatives or other suitable persons as foster parents and thereafter approve such person(s) to be foster parents, if qualified, and, if not, to report such fact to the Court, all parties and counsels, including the law guardian, forthwith [specify]: [Applicable where child in custody of Commissioner of Social Services]: “ ORDERED that if the child absconds from the above-named custodial person or facility, written notice shall be given within 48 hours to the Clerk of Court by the custodial person or by an authorized representative of the facility, stating the name of the child, the docket number of this procedure, and the date on which the child ran away. ; (and it is further) [Applicable Where Child is Native-American]: “ ORDERED that the following should be notified of this proceeding [specify]: the “ custodian of the child; “ tribe/nation; “ United States Secretary of the Interior “ ORDERED that in light of the assumption of jurisdiction by the tribe/nation, this petition is DISMISSED WITHOUT PREJUDICE; (and it is further) “ ORDERED that if the child remains in foster care or is directly placed pursuant to Sections 1017 or 1055 of the Family Court Act, a permanency hearing shall be held on [specify date certain]:2 ; (and it is further) “ ORDERED that ENTER ___________________________________ Judge of the Family Court Dated: NOTICE: PURSUANT TO SECTION 1113 OF THE FAMILY COURT ACT, AN APPEAL FROM THIS ORDER MUST BE TAKEN WITHIN 30 DAYS OF RECEIPT OF THE ORDER BY APPELLANT IN COURT, 35 DAYS FROM THE DATE OF MAILING OF THE ORDER TO APPELLANT BY THE CLERK OF COURT, OR 30 DAYS AFTER SERVICE BY A PARTY OR THE LAW GUARDIAN UPON THE APPELLANT, WHICHEVER IS EARLIEST. Check applicable box: 9 Order mailed on [specify date(s) and to whom mailed ]:___________________________ 9 Order received in court on [specify date(s) and to whom given]:_____________________ 2 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 halfsibling 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