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Affirmation Regarding Venue Form. This is a New York form and can be use in Family Court Statewide.
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Tags: Affirmation Regarding Venue, TPR-12, New York Statewide, Family Court
S.S.L.§384-b(3)(c-1)
[This form must be submitted
in cases where the termination petition was filed before
a judge other than the judge who heard the most recent
Family Court proceeding]
FAMILY COURT OF THE STATE OF NEW YORK
COUNTY OF
.........................................................................................
In the Matter of the Commitment of
Guardianship and Custody pursuant to
§ 384-b of the Social Services Law of
TPR-12
(Affirmation Regarding Venue–
Termination of Parental Rights )
(8/2010)
Docket No.
AFFIRMATION
REGARDING VENUE
CIN #
A Child under the Age of Eighteen Years
.....................................................................................
I , [specify name]:
,
duly admitted to practice law in the State of New York, affirm the following:
, an attorney
1. I represent [specify]:
, the Petitioner in the aboveentitled proceeding seeking termination of the parental rights of [specify]:
2. Upon information and belief, according to [specify agency having care and custody or
of child or other source of information]:
the child was placed in □ foster care □ other out-of-home care [specify]:
by the Hon.
, Judge of the Family Court,
County, on
[specify date]:
and remains under the jurisdiction of that Family Court.
3. Upon information and belief, according to [specify agency having care and custody of
child or other source of information]:
the child’s most recent permanency hearing was held before [specify judge or referee]
in Family Court, [specify county]:
, on [specify date]:
4. This termination of parental rights proceeding has been filed before this Court for the
following reasons [check applicable box(es) and explain]:
□ This Court is more familiar with the facts and circumstances regarding permanency
planning for, and the needs and best interests of, this child, because [specify]:
□ The child’s attorney [specify]:
is able to continue to represent the
child in this proceeding.
□ The attorney [specify]:
for the following Respondent [specify]:
is able to continue to represent the child in this proceeding. [If more than one Respondent,
include separate paragraphs for each].
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TPR-12
Page 2
□ Petitioner’s principal place of business is located in [specify county]
and Petitioner’s witness(es) would find it inconvenient to travel to the Family Court in [specify
county]:
□ This Court will be able to proceed in this matter more expeditiously because [specify]:
□ Other [specify]:
WHEREFORE, for the reasons stated above, I am requesting that this Court retain
jurisdiction over this termination of parental rights proceeding.
__________________________________________
Signature of Affirmant
__________________________________________
Affirmant’s Name (print or type)
__________________________________________
__________________________________________
__________________________________________
Affirmant’s Address and Telephone Number
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