F.C.A. §§360.2, 360.3 Form 3-41 (Juvenile Delinquency - Order on Violation of Probation or Conditional Discharge) 12/2015 At a term of the Family Court of the State of New York, held in and for the County of , at New York on ,. PRESENT: Hon. Judge __________________________________ In the Matter of A Person Alleged to be a Juvenile Delinquent, Docket No. ORDER (Violation of Order of Probation or Conditional Discharge) Respondent. ___________________________________ The above-named Respondent, having been adjudicated by this Court to be a juvenile delinquent within the meaning of Article 3 of the Family Court Act; and an Order of Disposition, dated , , having been made herein whereby Respondent was [check applicable box]: placed on probation conditionally discharged, upon certain terms and conditions; And the Presentment Agency having appeared, And the Respondent having appeared not appeared, And Counsel for the Respondent having appeared not appeared, And the Respondent having had an opportunity to be heard; The Court, after hearing, being satisfied by competent proof that the Respondent, [check applicable box]: did did not willfully and without just cause fail to comply with the terms and conditions in that: [specify provisions of order violated and nature of violations]: [Required where Order of Disposition is revoked]: And the Court, having determined that the Order of Disposition should be revoked and having fully considered the matter of a new disposition pursuant to Family Court Act §§ 352.2 and 360.3, determines that the Respondent requires the following disposition for the following reasons [specify; if the Respondent has been found to be sexually exploited, as defined in Social Services Law §447-a, so indicate]: American LegalNet, Inc. www.FormsWorkFlow.com Form 3-41 Page 2 Required Findings in Cases in Which the Respondent is Placed [The following determinations are required when Respondent is placed pursuant to F.C.A. §353.3; check applicable boxes and provide case-specific reasons]: The Court finds and determines that: A. Best Interests Finding: Continuation in or return to the Respondent's home would would not be contrary to Respondent's best interests based upon the following facts and for the following reasons [specify]: This determination is based upon the following information [check applicable box(es)]: Uniform Case Record, dated [specify]: Summary of the Uniform Case Record, dated [specify]: Service Plan, dated [specify]: Risk Assessment Instrument Probation Department report, dated [specify]: Mental health evaluation, dated [specify]: The report of [specify]: , dated [specify]: Testimony of [specify]: Other [specify]: B. Reasonable Efforts Findings: 1. Reasonable efforts, where appropriate and consistent with the need for protection of the community, to prevent or eliminate the need for removal of Respondent from the home, and, if the Respondent was removed prior to the date of the dispositional hearing regarding the violation, to return Respondent safely to his or her home: were made as follows [specify]: were not made but the lack of efforts was appropriate [check all applicable boxes]: because of a prior judicial finding pursuant to Family Court Act §352.2(2)(c)that the authorized agency was not required to make reasonable efforts to reunify the Respondent with the parent(s) guardian(s) [specify date of finding]: because of other reasons [specify]: were not made. This determination is based upon the following information [check applicable box(es)]: Uniform Case Record, dated [specify]: Summary of the Uniform Case Record, dated [specify]: Service Plan, dated [specify]: Risk Assessment Instrument Probation Department report, dated [specify]: Mental health evaluation, dated [specify]: The report of [specify]: , dated [specify]: Testimony of [specify]: American LegalNet, Inc. www.FormsWorkFlow.com Form 3-41 Page 3 Other [specify]: 2. [Applicable in cases in which the Respondent's permanency plan is adoption, guardianship or permanent living arrangement other than reunification]: Reasonable efforts to make and finalize the permanency plan of [specify]: were made as follows [specify]: were not made based upon the following facts and for the following reasons [specify; if lack of efforts was reasonable, so indicate]: This determination was based upon the following information [check applicable box(es)]: Uniform Case Record, dated [specify]: Summary of the Uniform Case Record, dated [specify]: Service Plan, dated [specify]: Risk Assessment Instrument Probation Department report, dated [specify]: Mental health evaluation, dated [specify]: The report of [specify]: , dated [specify]: Testimony of [specify]: Other [specify]: C. Findings Regarding Transitional Services and Out-of-State Placements: [Required where Respondent is 14 years of age or older]: The services, if any, needed to assist the Respondent to make the transition from foster care to independent living are [specify]: [Required where the Respondent is placed outside New York State]: Placement outside New York State is is not appropriate and in the Respondent's best interests. D. Findings Regarding Pre-dispositional Risk Assessment Instrument: There is is not a validated pre-dispositional risk assessment instrument in use in this county that was developed by (or in New York City, approved by) the New York State Office of Children and Family Services. [REQUIRED where there is a validated pre-dispositional risk assessment instrument in use]: Respondent has been assessed on the risk assessment instrument as a [check box for level of risk]: [NYC cases only]: low medium high very high level of risk [NON-NYC cases only]: low medium high level of risk . [REQUIRED where validated pre-dispositional risk assessment instrument is in use and where placement is at a higher level of care than the assessed risk level; omit if inapplicable]: Placement, as directed below, is necessary and no less restrictive alternative is available, both for the protection of the community and to be consistent with the needs and best interests of the Respondent, notwithstanding the assessed risk level, for the following reasons {specify]: American LegalNet, Inc. www.FormsWorkFlow.com Form 3-41 Page 4 NOW, therefore, it is hereby ORDERED, that the Order of Disposition is vacated continued ; (and it is further) ORDERED that [check applicable boxes]: Respondent is discharged with a warning. Respondent is conditionally discharged for a pe