FCA §§ 1035, 1036,1055 [NOTE: May be served outside New York State] Form 10-7c (Summons-Child Neglect Proceeding) 9/2006 FAMILY COURT OF THE STATE OF NEW YORK COUNTY OF _______________________________ ...................................................................................... In the Matter of a Proceeding under Article 10 of the Family Court Act Docket No.________ SUMMONS (CHILD NEGLECT CASE) CIN # Respondent ...................................................................................... NOTICE: PLACEMENT OF YOUR CHILD IN FOSTER CARE MAY RESULT IN YOUR LOSS OF YOUR RIGHTS TO YOUR CHILD. 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 TO COMMIT GUARDIANSHIP AND CUSTODY OF YOUR CHILD TO THE AGENCY FOR THE PURPOSES OF ADOPTION. IN SOME CASES, THE AGENCY MAY FILE BEFORE THE END OF THE 15-MONTH PERIOD. IF SEVERE OR REPEATED CHILD ABUSE IS PROVEN BY CLEAR AND CONVINCING EVIDENCE, THIS FINDING MAY CONSTITUTE THE BASIS TO TERMINATE YOUR PARENTAL RIGHTS AND TO COMMIT GUARDIANSHIP AND CUSTODY OF YOUR CHILD TO THE AGENCY FOR THE PURPOSES OF ADOPTION. BY ORDER OF THE FAMILY COURT OF THE STATE OF NEW YORK TO THE ABOVE-NAMED RESPONDENT(S) WHO RESIDE(S) OR IS FOUND AT [specify address(es)]: and to [specify name(s) and address(es) and relationship to child(ren)]: (A)(P)etition(s) under Article 10 of the Family Court Act having been filed with this Court, and annexed hereto YOU AND EACH OF YOU ARE HEREBY SUMMONED to appear before this Court at_________________________, New York, on _____________________, _____, at ______ o’clock in the Qmorning Qafternoon of that day to answer the petition and to be dealt with in accordance with Article 10 of the Family Court Act. On your failure to appear as herein directed, a warrant may be issued for your arrest. Dated:_______________, ____. __________________________________________ Clerk of Court American LegalNet, Inc. www.FormsWorkflow.com