F.C.A. §322.1 FAMILY COURT OF THE STATE OF NEW YORK COUNTY OF ------------------------------------------------------------------In the Matter of Docket No. Form 3-24 (Juvenile Delinquency- Modification of Order of Commitment) 6/2016 A Person Alleged to be Juvenile Delinquent, PETITION (Modification of Order of Commitment) Respondent. ------------------------------------------------------------------TO THE FAMILY COURT: The undersigned, appearing on behalf of the Petitioner, respectfully alleges that: 1. (a) Petitioner is " the Commissioner of Mental Health " the Commissioner of the Office of People with Developmental Disabilities " related to Respondent in the aboveentitled proceeding as follows [specify]: and is appearing on behalf of the Respondent for the purpose of filing this petition. (b) Respondent has been committed to a residential facility within the appropriate office of the Office of Mental Hygiene. 2.Petitioner believes that the continued commitment of the above-named child in such residential facility is no longer appropriate in that [ specify]: WHEREFORE, Petitioner requests a hearing for a modification of the order of commitment, dated , to authorize the transfer of Respondent to a non-residential facility. Dated: _________________________ Commissioner By_______________________ Name _________________________ Title OR By_____________________________ Person Appearing on Behalf of the Respondent VERIFICATION American LegalNet, Inc. www.FormsWorkFlow.com Form 3-24 Page 2 (Agency) ) ) ss.: COUNTY OF_______________________ ) _________________________________________, being duly sworn, deposes and says: That (s)he is the______________________________ of ____________________, an agency authorized to originate the above- entitled proceeding, and is acquainted with the facts and circumstances therein; that (s)he has read the foregoing 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 as to those matters (s)he believes it to be true. _____________________________ Name _____________________________ Title Sworn to before me this _____ day of _________________, _____ . ________________________________________ Notary Public VERIFICATION (Individual) ) ) ss.: COUNTY OF_____________________ ) _____________________________________________, being duly sworn, deposes and says: That (s)he is the__________________________________________________ in the above-entitled proceeding and is acquainted with the facts and circumstances therein; that (s)he has read the foregoing 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 as to those matters (s)he believes it to be true. _____________________________ Sworn to before me this _____ day of _____________, _____ . _________________________________ (Deputy) (Clerk of the Court) (Notary Public) STATE OF NEW YORK STATE OF NEW YORK American LegalNet, Inc. www.FormsWorkFlow.com