F.C.A. §§ 651, 1030, 1081 D.R.L. §§ 72, 240 Form 10-25 (Child Protective – Petition for Visitation) (9/2006) FAMILY COURT OF NEW YORK COUNTY OF ...................................................................................... In the Matter of Docket No. CIN # (A) Child(ren) under Eighteen Years of Age Alleged to be Neglected or Abused by PETITION FOR VISITATION Respondent(s) .................................................................................... The undersigned Petitioner(s) respectfully alleges that: 1.Petitioner(s) (is)(are) the “ father “ mother “ grandparent(s)) of [specify child(ren)]: , who (is)(are) in the temporary custody of the Commissioner of Social Services of the County of [specify]: , pursuant to an order of the Family Court, dated [specify]: 2. As a result of [check applicable box]: “ written agreement, dated [specify]: [specify]: “ order of the [specify court and county]: Petitioner(s) have the following visitation rights [specify]: between Petitioner(s) and , dated [specify]: A copy of the [check box]: “ written agreement “ court order is attached and made a part of this petition. 3. There have been no subsequent “ written agreements “ court orders affecting these visitation rights. 4. The subject child “ is “ is not a Native-American child, who is subject to the Indian Child Welfare Act of 1978 (25 U.S.C. §§ 1901-1963). WHEREFORE, Petitioner(s) request(s) an order enforcing the above rights of visitation and for such other and further relief as the court may deem just and proper. Dated , . __________________________________________ Petitioner American LegalNet, Inc. www.FormsWorkflow.com Form 10-25 Page 2 __________________________________________ Print or Type Name __________________________________________ Signature of Attorney, if any __________________________________________ Attorney’s Name (print or type) __________________________________________ __________________________________________ __________________________________________ Attorney’s Address and Telephone Number VERIFICATION STATE OF NEW YORK ) )ss.: COUNTY OF ) being duly sworn, deposes and says: That (s)he is and is acquainted with the facts and circumstances of the above-entitled proceeding; that (s)he has read the foregoing petition and knows the contents thereof; that the same is true to (his)(her own knowledge except as to those matters therein stated to be alleged upon information and belief, and that as to those matters (s)he believes it to be true. Petitioner Sworn to before me this day of _______________________ (Deputy) (Clerk of the Court) (Notary Public) American LegalNet, Inc. www.FormsWorkflow.com