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Petition (Termination Of Parental Rights - Abandonment) Form. This is a New York form and can be use in Family Court Statewide.
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Tags: Petition (Termination Of Parental Rights - Abandonment), TPR-6, New York Statewide, Family Court
Soc. Serv. Law§§ 384-b, 384-c
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-6
(Termination of Parental
Rights- Abandonment)
(9/2006)
Docket No.
PETITION
(ABANDONMENT)
CIN #
A Child under the Age of Eighteen Years,
alleged to be an Abandoned Child
...............................................................................................
IF THIS PETITION IS GRANTED, YOU MAY LOSE YOUR RIGHTS TO YOUR CHILD
AND YOUR CHILD MAY BE ADOPTED WITHOUT YOUR CONSENT AND WITHOUT
NOTICE TO YOU.
IF YOU ARE THE PARENT, FOSTER PARENT OR CUSTODIAN OF THE CHILD, YOU
HAVE A RIGHT TO HAVE A LAWYER REPRESENT YOU. IF YOU CANNOT AFFORD A
LAWYER, YOU MAY ASK THE COURT TO APPOINT A LAWYER TO REPRESENT YOU
WITHOUT FEE.
TO THE FAMILY COURT:
The undersigned Petitioner respectfully alleges that:
1. Petitioner(s)
, (is) (are)
G an authorized agency having its office and place of business at [specify, including county]:
G foster parent(s) residing at [specify, including county]:
G law guardian G guardian ad litem filing at the Court’s direction, pursuant to Social Services
Law §384-b(3)(b).
2 a.
is a Gmale Gfemale child under the age of
eighteen years, born on [specify]:
, at [specify]:
, who now
resides at [specify, including county]:
.
b. The subject child is is not a Native-American child, who is subject to the Indian Child
Welfare Act of 1978 (25 U.S.C. §§ 1901-1963). If so, the following have been notified [check
applicable box(es)]: parent/custodian [specify name and give notification date]:
tribe/nation [specify name and give notification date]:
United States Secretary of the Interior [give notification date]:
3. The full name and last-known address of each parent and custodian of the child, if known, are:
Name
Last-Known Address
4. a. The name and last-known address of each other interested party who should be afforded notice
of this proceeding are:
Name
Last-Known Address
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b. The name and last-known address of each other person entitled to notice of an adoption
pursuant to Domestic Relations Law § 111-a are:
Name
Last-Known Address
c. There are no persons other than those set forth entitled to notice of this proceeding or of an
adoption of the child.
5. The child came into the care of an authorized agency on [specify]:
, under the
following circumstances: [include court, county, docket number and date(s) of prior proceedings; if the
child was abandoned at the age of five days or younger and a finding of aggravated circumstances was
made, so indicate, including date]:
6. (Upon information and belief) (T)(t)he respondent(s), G father G mother (has)(have) evinced
an intent to forego (his)(her)(their) parental rights and obligations as manifested for the period of six
months immediately prior to the initiation of this proceeding by [specify]:
7. The parent(s) (was) (were) able to communicate and visit and were not prevented nor
discouraged from doing so by the agency.
8. The best interests of the child require the commitment of the guardianship and custody of the
child to G an authorized agency G foster parent(s) for the following reasons [specify;
if appropriate, include facts regarding a non-respondent parent]:
9. The child is is not under the jurisdiction of the Family Court. If so, this petition has
has not been filed in the Court that exercised jurisdiction over the most recent permanency or other
proceeding involving this child. [If it has not been so filed, petitioner must file affirmation, Form TPR12].
10. No previous application has been made to any court or judge for the relief sought herein (except
[specify]:
WHEREFORE, the Petitioner requests an order determining that the above-named child is an
abandoned child, and committing the guardianship and custody of the child to
G an authorized agency G foster parent(s), and for such other and further relief as in the interests of
the child may be granted.
Dated:
.
G Agency by:
Name
Title
G Foster parent:
Print or type name
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Signature of Attorney, if any
Attorney’s Name (Print or Type)
Attorney’s Address and Telephone Number
VERIFICATION (Agency)
STATE OF NEW YORK
COUNTY OF
)
ss.:
)
being duly sworn,
deposes and says:
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
VERIFICATION (Individual)
STATE OF NEW YORK
COUNTY OF
)
)SS.:
)
, 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
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