Sec. 749(a) F.C.A. Form 7-7 (Person in Need of Supervision) 7/83 FAMILY COURT OF THE STATE OF NEW YORK COUNTY OF In the Matter of A Person Alleged to be A Person In Need of Supervision, TO THE FAMILY COURT: The undersigned Petitioner respectfully alleges that: 1. (S) (He) was the Petitioner and that proceeding. was the Respondent in the above-entitled Docket No. APPLICATION TO RESTORE CALENDAR 2. On . ____, an order in the above-entitled proceeding was entered whereby said proceeding was adjourned in contemplation of dismissal until upon the following terms and conditions: A copy of said order is annexed as Exhibit A. 3. Respondent has not abided by said terms and conditions in that: 4. No previous application has been made to any court or judge for the relief requested herein (except WHEREFORE the Petitioner requests that this matter be restored to the calendar of the Family Court of County. Petitioner Dated: , ____, American LegalNet, Inc. www.USCourtForms.com VERIFICATION (Individual) STATE OF NEW YORK ) ss.: being duly sworn, deposes and says: in the above-entitled proceeding and is acquainted with That (s)he is the 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) 2002 © American LegalNet, Inc. VERIFICATION (Agency) STATE OF NEW YORK 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 2002 © American LegalNet, Inc.