F.C.A. §§352.2(2)(c); 754(2)(b); 1039-b; 1052(b)(i)(A); S.S.L. §358-a(3)(b) General Form 36-b (Affidavit in Support of Motion that Reasonable Efforts Not Required) (9/2009) FAMILY COURT OF THE STATE OF NEW YORK COUNTY OF ......................................................................................... In the Matter of Docket No. CIN # A Child/Children Alleged to be GAbused GNeglected GVoluntarily Placed in Foster Care GJuvenile Delinquent GPerson in Need of Supervision ......................................................................................... ) ) SS.: COUNTY OF NEW YORK ) STATE OF NEW YORK AFFIDAVIT IN SUPPORT OF MOTION FOR AN ORDER THAT REASONABLE EFFORTS ARE NOT REQUIRED , [check if applicable]: G an attorney duly admitted to practice law in the State of New York, (swears) (affirms) the following to be true under the penalties of perjury: 1. (Upon information and belief,)[Specify child(ren)]: the above-named child(ren), was/were removed from his/her/their home on [specify date]: and was/were G remanded Gplaced in foster care on [specify date]: , as a result of a proceeding under GArticle of the Family Court Act GSection of the Social Services Law. , 2. The status of the case is as follows [specify most recent court action, date of factfinding, disposition and/or most recent permanency hearing, if any; if child(ren) was/were surrendered by or had parental rights terminated with respect to one parent, so indicate with date]: 3. The permanency plan for the child(ren) is [specify]: . This plan G has Ghas not changed since the most recent dispositional or permanency hearing. American LegalNet, Inc. www.FormsWorkFlow.com General Form 36-b Page 2 4. This Court should issue an order that reasonable efforts to reunify the above-named child(ren) with the following parent(s) [specify]: are no longer required for the following reason(s)[check applicable box(es)]: G (Upon information and belief), the following parent(s)[specify]: subjected the child(ren) to the following "aggravated circumstances:" as defined in Family Court Act §1012(j): G 1). The Family Court found that the following parent(s)[specify]: committed G severe G repeated child abuse against the child(ren) as defined in subdivision 8 of Social Services Law §384-b [specify prior finding(s) or conviction(s) for acts or crimes constituting severe or repeated child abuse, including child(ren)'s name(s), court(s), county(ies) or, in the case of criminal convictions, other jurisdiction(s) and date(s) and, in the case of Family Court finding(s) of severe or repeated abuse, the burden of proof by which such finding(s) were made]: G 2). The Family Court found that the following parent(s)[specify]: abused the child(ren), as defined in paragraph G(i) G(iii) of subdivision (e) of section 1012 of the Family Court Act, within five years after the child(ren)'s return home following placement in foster care as a result of a Family Court finding of neglect, as defined in subdivision (f) of section 1012 of the Family Court Act, by the above-named parent(s) [specify findings of abuse and neglect, including child(ren)'s name(s), court(s), county(ies) and date(s) of findings, and, with respect to the neglect finding, the date(s) of the child(ren)'s placement and of return home]: G 3). The Family Court found, by clear and convincing evidence, that the following parent(s)[specify]: has/have refused and has/have failed completely for the following period [specify dates of period in excess of six months from date of child(ren)'s removal from home]: to engage in the following services necessary to eliminate the risk of abuse or neglect to the child(ren) if returned home [specify, including agencies or programs to which agency referred the parent(s), including dates of the referrals]: The Court also found that this failure was not justified by lack of child care, lack of transportation, conflict with work schedule or other adequate justification and that the parent(s) failed to arrange alternate services independently. On [specify date]: , after being warned by the Court that such an admission might result in an order that reunification services are not required, the parent(s) stated in Court under oath that G he Gshe Gthey intend(s) to continue to refuse such services and is/are unwilling to arrange services independently. G 4). The Family Court found that the child(ren) was/were abandoned at the age of five days or younger by the following parent(s)[specify]: with an intent to wholly abandon such child(ren) and with the intent that the child(ren) be safe from physical injury and cared for in an appropriate manner [specify child(ren)'s name(s), court, county, date, circumstances or location of child(ren) when found and grounds for finding]: American LegalNet, Inc. www.FormsWorkFlow.com General Form 36-b Page 3 G 5). (Upon information and belief), the parental rights of the following parent(s)[specify]:' to a sibling or half-sibling of the child(ren) were involuntarily terminated [specify name and date of birth of such child, court, county, and date]: WHEREFORE, for the reasons stated above, affiant respectfully requests this Court to issue an order granting the Petitioner's motion for an order that reasonable efforts are not required to reunify the child(ren) with the following parent(s) [specify]: , and for such other and further relief as the Court may deem just and proper. Affiant Sworn to before me this day of , (Deputy) Clerk of the Court Notary Public American LegalNet, Inc. www.FormsWorkFlow.com