F.C.A §§651, 652, 654; D.R.L §240 General Form 18 (Order on Petition for Custody or Visitation) 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 a Proceeding for 9 Custody 9 Visitation under 9 Article 6 of the Family Court Act 9 Section 240 of the Domestic Relations Law Petitioner, against Respondent ................................................................................ NOTICE: YOUR WILLFUL FAILURE TO OBEY THIS ORDER MAY RESULT IN INCARCERATION FOR CRIMINAL CONTEMPT. The Petitioner herein having filed a petition on [specify date]: , , pursuant to " Article 6 of the Family Court Act " Section 240 of the Domestic Relations Law, requesting an order of " custody " visitation of the following minor children [list each child as follows]: Name of Child: Date of Birth: Family File No.: Docket No. " FINAL ORDER " TEMPORARY ORDER ON PETITION FOR " CUSTODY " VISITATION [Check applicable box(es)]: And the Respondent having " been served " not been served with a copy of the petition, and having " been advised by the Court of the right to counsel, and having " appeared " not appeared before this Court to answer the petition and to show cause why it should not be granted; and having " consented " not consented to the relief requested in the petition; " And the Court having searched the statewide registry of orders of protection, the sex offender registry and the Family Court's warrant and child protective records, and having notified the attorneys for the parties and for the child [check if applicable]: " and the following self-represented party or parties [specify]: of the results of these searches; " And the Court having considered and relied upon the following results of these searches in making this decision [specify; if no results found, so indicate]: [Required in cases involving Native-American children where petitioner and/or respondent American LegalNet, Inc. www.FormsWorkFlow.com General Form 18 Page 2 are not parents of the child; check box if applicable and attach Addendum to Order (General Form GF-32 - Findings of Fact and Conclusions of Law ­ Indian Child Welfare Act)]: " And the following having been duly notified [check applicable box(es)]: " parent/custodian " tribe/nation [REQUIRED] " United States Secretary of the Interior [REQUIRED if tribal contact undetermined]; And the tribe/nation having: " appeared and participated as a party; " appeared and declined to assume jurisdiction; " appeared and requested transfer of jurisdiction;1 " not appeared; " And the required findings of fact and conclusions of law having been made pursuant to the Indian Child Welfare Act and having been attached in an Addendum to this Order; [Applicable to TEMPORARY orders only where less than 90 days have elapsed since last record review]: " And the Court, having dispensed with the search of the statewide registry of orders of protection, the sex offender registry and the Family Court's warrant and child protective records because these databases had been reviewed within the past 90 days; [Applicable where a party had made an allegation of domestic violence or child abuse; findings must be stated on the record, included in a written decision OR included in this order; check applicable box]: Q And the Court having explained its findings on alleged domestic violence or child abuse on the record; Q And the Court having issued a written decision containing its findings on alleged domestic violence or child abuse; Q And the Court having found that the allegation that [specify party]: had committed domestic violence or child abuse against [specify party or child(ren)]: Q was Q was not proven by a preponderance of the evidence, and having considered the effect of such domestic violence or child abuse upon the best interests of the child(ren) and relevant facts and circumstances as follows in making this order [specify how findings, facts and circumstances were factored into this Order]: [Applicable where hearing was heard jointly 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 heard jointly with the " custody " guardianship petition, Docket # [specify]: [NOTE: Attach or insert the ADDENDUM TO FINDINGS OF FACT to this form where Petitioner or Respondent is a Respondent, Non-respondent parent, relative or other nonparent in a child protective, destitute child dispositional or permanency proceeding and where the hearing in the child custody matter was consolidated with the child protective or destitute child dispositional or permanency hearing, pursuant to F.C.A. §§1055-b, 1089-a or 1096] AND THE MATTER HAVING DULY COME ON TO BE HEARD BEFORE THIS COURT, NOW, after examination and inquiry into the facts and circumstances of the case and after hearing the proofs and testimony offered in relation thereto, this Court finds and determines that: If an oral application was made or a written petition was filed requesting transfer of the case to a tribal court, an order determining the request, General Form GF-20, must also be issued. American LegalNet, Inc. www.FormsWorkFlow.com 1 General Form 18 Page 3 [For modification cases: delete if inapplicable]:2 The following change of circumstances has occurred since the entry of the "order "judgment, dated [specify]: , of "custody "visitation [specify change in circumstances]: And this Court further finds and determines that [specify]: And it is therefore ORDERED that the best interests of the above-named child or children require [check applicable box(es)]: "custody "visitation to be as follows [specify]: ; and it is further [Applicable to cases involving a party or parties in the military; check box(es) if applicable]: " ORDERED that, since " Petitioner " Respondent is on active duty, deployed or temporarily assigned to military service and since such service affects such party's ability to act as a joint or primary custodian of the child(ren), the return of such party from such active duty shall constitute a substantial change of circumstances sufficient to entitle such party to a review of this Order for possible modification if in the child(ren)'s best interests, unless the parties and child(ren)'s attorney have otherwise stipulated or agreed; and it is further