F.C.A §§ 1071, 1072 Form 10-14 (Child Protective­ Violation of Order of Disposition) 6/2016 At a term of the Family Court of the State of New York, held in and for the County of , at New York on , . PRESENT: Hon. Judge ......................................................................... In the Matter of FAMILY FILE #: CIN # A Child under Eighteen Years of Age Alleged to be neglected abused by Docket No. ORDER (Violation of Order of Disposition) Respondent(s) ......................................................................... NOTICE: WILLFUL FAILURE TO OBEY THE TERMS AND CONDITIONS OF THIS ORDER MAY RESULT IN COMMITMENT TO JAIL FOR A TERM NOT TO EXCEED SIX MONTHS. 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 NEXT PERMANENCY HEARING SHALL BE HELD ON [specify date/time:]:1 If child has been placed, specify a date certain, in most cases the previously-scheduled date, not more than eight months from removal of the child from home or not more than six months from the completion of the most recent permanency hearing. No date needs to be set if : (I) the petition is dismissed; or (ii) the child has not been removed from home; or (iii) has been finally discharged from care; or (iv) custody or guardianship was ordered pursuant to Family Court Act Article 6. 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 half-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 1 Form 10-14 Page 2 The above-named child(ren) having been adjudicated to be [check applicable box(es)]: neglected abused severely abused repeatedly abused within the meaning of Article 10 of the Family Court Act; And an Order of Disposition dated [specify]: this court requiring the following Respondent(s) [specify]: and conditions of an Order of [check applicable box(es)]: Suspended Judgment Protection Supervision , having been made in to comply with the terms Placement Release And a motion, order to show cause or petition having been filed alleging that the Order of Disposition has been violated and notice having been duly given to the Respondent(s); And Respondent(s) [specify]: having:2 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 not appeared but counsel appeared; And Respondent(s) having: voluntarily, intelligently and knowingly admitted in open court that (s)he committed the following act(s) in violation of the Order of Disposition [specify]: denied the allegations of the petition and the matter having duly come on for a hearing before this Court ; not appeared and the matter having duly come on for a fact-finding hearing by inquest before this Court; [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 proof and testimony offered in relation to the case; accepting the admission by Respondent(s) [specify]: finds and determines by competent proof that the following Respondent(s) [specify]: willfully and without just cause disobeyed and failed to obey the Order in that [specify provision(s) of order violated and nature of violation]: 2 Insert separate paragraphs for each Respondent, if necessary. American LegalNet, Inc. www.FormsWorkFlow.com Form 10-14 Page 3 did not willfully and without just cause violate the Order. [Applicable only where the Court determined that the Respondent(s) violated the Order; check box if applicable]: And the matter having thereafter duly come on for a dispositional hearing before the Court, [Applicable only where hearing was consolidated with hearing of Family Court Act Article 6 custody or guardianship petition, pursuant to Family Court Act §1055-b; check box if applicable]: And the hearing having been consolidated with the " custody " guardianship petition, Docket # [specify]: [Required findings in cases where the child(ren), who had NOT been ordered removed earlier in the case, is/are ordered removed and/or placed; otherwise, skip I and II and, if child remains in foster care, go to III]: The Court finds and determines that: I. Required "Best Interests" and "Reasonable Efforts to Prevent Removal" Findings [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 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 him/her/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 [check all applicable boxes]: G because of a prior 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