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 ) (9/2006) 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 G foster care G 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]: G 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]: G The child’s law guardian [specify]: is able to continue to represent the child in this proceeding. G 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]. American LegalNet, Inc. www.FormsWorkflow.com TPR-12 Page 2 G 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]: G This Court will be able to proceed in this matter more expeditiously because [specify]: G 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 American LegalNet, Inc. www.FormsWorkflow.com