F.C.A 247 1034(2) Form 10 - 29 (Child Protective -- Order on Application for Access to Child(ren) and/or Home Before Petition Filed) (3/2018) 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. A Child(re n) under the Age of ORDER ON APPLICATION Eighteen Years Alleged to be F OR ACCESS TO Abused or Neglected by CHILD(REN) AND/OR HOME (Before Petition Filed) Respondent(s) An application pursuant to section 1034(2) of the Family Court Act having been made before this Court [check box]: in person by telephone; And the following person(s) having participated [check applicable box(es) and s pecify]: Petitioner/Applicant/Child protective investigator [specify name, title and agency]: Other [specify, if any]: And t he parent or other person legally responsible having been notified by the child protective investigator tha t, if access to the child and/or home, as applicable, was denied, the investigator may seek an immediate court order for such access; The Court finds and determines that , based upon a report of suspected abuse or maltreatment, pursuant to Article 6 of the Social Services Law, and other information learned in the child protective investigat ion and reported to the Court, [ check all applicable box(es) ]: A. danger, but the child protective investigator was: unable to locate the child or other children in the household; or denied access to the child or children sufficient to determine his/her/their safety; B. There is probable cause to believe that an abused or neglected child or children may be located on the premises, but the child protective investigator was denied access to the home to investigate; American LegalNet, Inc. www.FormsWorkFlow.com Form 10 - 29 Page 2 NOW, therefore, it is [ check appl icable box(es)]: ORDERED that the application is hereby [check applicable box(es) and specify]: GRANTED OR DENIED ; (and it is further) [Applicable where application has been GR ANTED and FINDING 266 A , above, has been checked; check all applicable box(es) and specify]: ORDERED that the parent or other person legally responsible shall immediately at any hour between the hours of 6AM and 9 PM bring the following child o r children [specify names]: for observation and interviews outside the presence of the parent or other person legally responsible: to the following Child Advocacy Center [specify name and address]: to the following person fo r an interview and obs ervation [specify name and address of interview/observation location]: to the Petitioner/Applicant fo r an interview and observation as follows [specify, including address of interview/observation]: [Applica ble where application has been GRANTED and FINDING 266 B , above, has been checked; check all applicable box(es)]: ORDERED that the parent or other person legally responsible shall permit the child protective investigator to enter the home: immediat ely at any hour between the hours of 6AM and 9 PM in order to: determine whether an abused or neglected child or children is/are present; conduct a home study to evaluate the home environment of the child or children; (and it is further) [Applicable where application has been GRANTED; check applicable box(es)]: ORDERED that the [check applicable box]: New York City Police Department local police agency is to provide assistance to the child protective investigator in enterin g the home, if necessary. [REQUIRED in all cases in which the application has been GRANTED; check box if applicable]: ORDERED that the Petitioner/Applicant shall report back to this Court within three business days regarding what, if any, find ings have been made and what, if any, actions have been taken with respect to the child and/ or other children in the household; (and it is further) ORDERED that [specify]: . ENTER Judge of the Family Court Dated: American LegalNet, Inc. www.FormsWorkFlow.com Form 10 - 29 Page 3 PUR SUANT 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 CL ERK OF COURT, OR 30 DAYS AFTER SERVICE BY A PARTY OR THE ATTORNEY FOR THE CHILD UPON THE APPELLANT, WHICHEVER IS EARLIEST. Check applicable box(es): Order transmitted on [specify date]: by: facsimile e - mail Order received in court on [specify date(s) and to whom given]: Order mailed on [specify date(s) and to whom mai led ]: American LegalNet, Inc. www.FormsWorkFlow.com