Soc. Serv. Law.§§384-b(13); F.C.A § 635; 636; 637 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 Form TPR-15 (Petition to Restore Parental Rights) (8/2010) Docket No. PETITION FOR MODIFICATION OF ORDER OF DISPOSITION TO RESTORE PARENTAL RIGHTS CIN# A Child under the Age of Eighteen Years, Whose Parent’s Rights Were Terminated ........................................................................................... TO THE FAMILY COURT: The undersigned Petitioner(s) respectfully allege(s) that: 1. Petitioner(s) , (is) (are) □ respondent-parents (s) in the case in which parental rights were terminated □ an authorized agency having its office and place of business at [specify, including county]: □ individual to whom guardianship and custody of the child had been committed. □ attorney for the child 2. The parental rights of [specify]: to the above-named child were terminated two or more years prior to the filing of this petition by an order of the Court, dated [specify]: and custody and guardianship of the child were committed to [specify]: A certified copy of the order terminating parental rights is attached and made part of this petition. 3. The order committing guardianship and custody of the child had been based upon an adjudication upon the following grounds: ❑ The parent or parents, whose consent to the adoption of the child would otherwise be required, was/were found to have abandoned such child for the period of six months immediately prior to the date on which the petition was filed in the court; ❑ The parent or parents, whose consent to the adoption of the child would otherwise be required, was/were found to be presently and for the foreseeable future unable, by reason of mental illness or mental retardation, to provide proper and adequate care for a child who had been in the care of an authorized agency for the period of one year immediately prior to the date on which the petition was filed in the court; ❑ The child was found to be a permanently neglected child; American LegalNet, Inc. www.FormsWorkFlow.com Form TPR-15 Page 2 4. a. The parent(s) whose rights had been terminated and to whom parental rights are sought to be restored consent(s) to the relief requested in this petition. b. (i) The petitioner in the case in which parental rights were terminated [check box]: ❑ consents to the relief requested in this petition. ❑ refuses to consent to the relief requested in this petition, but such refusal is without good cause because [specify]: -OR(ii) ❑ I do not know whether the petitioner in the underlying termination of parental rights proceeding consents to the relief requested in this petition. □ c. [Applicable if individual to custody and guardianship was committed was not the petitioner in the termination of parental rights action; check box, if applicable]: (i) The individual to whom guardianship and custody of the child had been committed: ❑ consents to the relief requested in this petition. ❑ refuses to consent to the relief requested in this petition, but such refusal is without good cause because [specify]: -OR(ii) ❑ I do not know whether the individual to whom guardianship and custody of the child had been committed in the underlying termination of parental rights proceeding consents to the relief requested in this petition. 5. The child is fourteen years of age or older, is under the jurisdiction of the Family Court, has not been adopted and consents to the relief requested in this petition. 6. The best interests of the child require the restoration of parental rights of [specify] because [specify]: 7. No previous application has been made to any court or judge for the relief sought herein ❑ except [specify, if applicable]: WHEREFORE, the Petitioner requests an order modifying the order of disposition of the termination of parental rights proceeding to restore parental rights and for such other and further relief as this Court deems just and proper. Dated: . American LegalNet, Inc. www.FormsWorkFlow.com Form TPR-15 Page 3 Name Title Print or type name: ____________________ Signature of Attorney, if any Attorney’s Name (Print or Type): Attorney’s Address and Telephone Number VERIFICATION (Petition Brought by Individual) STATE OF NEW YORK ) ss.: COUNTY OF ) , being duly sworn, says that (s)he is the Petitioner in the above-entitled proceeding and that the foregoing petition is true to (his) (her) own knowledge, except as to matters herein stated to be alleged on information and belief and as to those matters (s)he believes it to be true. Petitioner Sworn to before me this day of . (Deputy) Clerk of the Court Notary Public VERIFICATION (Petition Brought by Agency) STATE OF NEW YORK COUNTY OF ) ss.: ) being duly sworn, states the following: That (he) (she) is a duly constituted official of the above-named authorized agency, to wit, its ; That (he) (she) has read the foregoing Petition and knows the contents thereof; that the same is true to (his) (her) own knowledge except as to matters therein stated to be alleged on information and belief and that as to those matters (he) (she) believes it to be true. Agency Official Sworn to before me this day of (Deputy) Clerk of the Court Notary Public , . American LegalNet, Inc. www.FormsWorkFlow.com