F.C.A§ 661; S.C.P.A.§ 1707 Form 6-5 (Order Appointing Guardian of the Person or Permanent Guardian) 8/2010 At a term of the Family Court of the State of New York, held in and for the County of , at New York, on . P R E S E N T: Hon. Judge ____________________________________________ Proceedings for the Appointment of a Docket No. Guardian of the Person Permanent Guardian Family File No. of ORDER APPOINTING Guardian of the Person Permanent Guardian a Person Under the Age of 21 ____________________________________________ _________ Upon reading and filing the petition, duly verified on , , applying for the appointment of the guardian of the person permanent guardian of the above-named person under the age of 21; [Delete if inapplicable] And where the subject of the petition is 18 years of age or older, he/she having consented to the appointment of the guardian; And where the subject of the petition is over 14 but less than 18 years of age, the child having expressed a preference for the appointment of the guardian; And this Court having determined that the best interests of the subject of the petition will be promoted by the appointment of a guardian of the person permanent guardian , and that [specify guardian]: is in all respects competent to act as such guardian and to raise the subject of the proceeding to adulthood; [Applicable to cases where Petitioner is a relative or other non-parent and where hearing was consolidated with child protective dispositional or permanency hearing, pursuant to F.C.A. §§1055-b or 1089-a; delete if inapplicable]: And this Court having determined that: Termination of the order placing or remanding the child(ren) pursuant to Article 10 or 10-A of the Family Court Act will will not not jeopardize the child(ren)'s safety and is is not in the best interests of the child(ren). American LegalNet, Inc. www.FormsWorkFlow.com Form 6-5 Page 2 The child(ren)'s birth mother has has not consented to the award of guardianship to the Petitioner. If not, the following extraordinary circumstances support Petitioner's standing to seek guardianship of the child(ren) [specify]: The child's legally-established birth father has has not consented to the award of guardianship to the Petitioner. If not, the following extraordinary circumstances support Petitioner's standing to seek guardianship of the child(ren) [specify]: The child has been living with the following foster parent(s)[specify]: for a period in excess of one year, who has/have has/have not consented to the award of guardianship to the Petitioner. The local department of social services, the petitioner in the related child abuse or neglect permanency proceeding has has not consented to the award of guardianship to the Petitioner. The attorney for the child(ren) [specify]: child abuse or neglect permanency proceeding of guardianship to the Petitioner. in the related has not consented to the award has IT IS HEREBY ORDERED that [specify guardian]: , upon taking the official oath and filing the designation as required by law, is appointed guardian of the person permanent guardian of [specify name of subject of the petition]: child upon the following terms and conditions [specify]: and that Letters of Guardianship shall issue to the Guardian accordingly; and it is further ORDERED that, unless terminated by the Court, the appointment shall last until the subject's [check applicable box]: 18th birthday, unless the Court approves an application for an extension of the appointment until the age of 21 upon the consent of the subject if the subject is over 18; OR st 21 birthday, since the subject is over 18 and has consented to the appointment until he/she reaches the age of 21; [Applicable to cases where hearing was consolidated with child protective dispositional or permanency hearing, pursuant to F.C.A. §§1055-b or 1089-a; delete if inapplicable]: ORDERED that the following local department of social services [specify]: and the following attorney for the child(ren)[specify]: shall be notified and shall be made parties to any subsequent proceedings for modification, enforcement or termination of the Order; American LegalNet, Inc. www.FormsWorkFlow.com Form 6-5 Page 3 AND IT IS FURTHER ORDERED that [specify]: ENTER _____________________________________ Judge of the Family Court Dated: , . PURSUANT TO SECTION 1113 OF THE FAMILY COURT ACT, AN APPEAL FROM THIS ORDER MUST BE TAKEN WITHIN 30 DAYS OF RECEIPT OF THE ORDER BY APPELLANT IN COURT, 35 DAYS FROM THE DATE OF MAILING OF THE ORDER TO APPELLANT BY THE CLERK OF COURT, OR 30 DAYS AFTER SERVICE BY A PARTY OR THE ATTORNEY FOR THE CHILD UPON THE APPELLANT, WHICHEVER IS EARLIEST. Check applicable box: 9 Order mailed on [specify date(s) and to whom mailed ]:___________________________ 9 Order received in court on [specify date(s) and to whom given]:_____________________ American LegalNet, Inc. www.FormsWorkFlow.com