F.C.A. §§ 764, 765, 766, 767 Form 7-10 (Person in Need of Supervision--Order on Petition to Terminate Placement) 8/2010 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 In Need of Supervision Docket No. ORDER ON PETITION TO TERMINATE PLACEMENT Respondent .......................................................................... The Respondent having been adjudicated by this Court to be a person in need of supervision within the meaning of Article 7 of the Family Court Act, and an Order, dated , , having been made herein placing the Respondent with ; and , a (parent) (guardian)(duly authorized agency) (next friend) of the Respondent having filed a petition herein, sworn to on , , for an order terminating the placement; and A copy of the petition having been served upon , the duly authorized agency or institution having custody of the Respondent; and the Court having examined the petition (and the answer thereto), and having concluded that (no) (a) hearing should be had (and the matter having duly come on to be heard); and It appearing to this Court that continued placement Gwould Gwould not serve the purpose of Article 7 of the Family Court Act; it is hereby American LegalNet, Inc. www.FormsWorkFlow.com Form 7-10 page 2 [Check applicable box(es)]: G ORDERED that the relief sought herein is denied and the petition be and the same hereby is dismissed; G ORDERED that the aforesaid order of placement dated hereby is modified in the following respects: , ; , be and the same G ORDERED that the Respondent be and (s)he hereby is placed on probation under the supervision of the Probation Department of the County of , upon the 1 following terms and conditions of probation : G ORDERED that PURSUANT TO SECTION 1113 OF THE FAMILY COURT ACT, AN APPEAL FROM THIS ORDER MUST BE TAKEN WITHIN 30 DAYS OF RECEIPT OF THE ORDER BY APPELLANT IN COURT, 35 DAYS FROM THE DATE OF MAILING OF THE ORDER TO APPELLANT BY THE CLERK OF COURT, OR 30 DAYS AFTER SERVICE BY A PARTY OR THE ATTORNEY FOR THE CHILD UPON THE APPELLANT, WHICHEVER IS EARLIEST. ENTER _________________________________ Judge of the Family Court . Dated: , . Check applicable box: 9 Order mailed on [specify date(s) and to whom mailed]:________________________ 9 Order received in court on [specify date(s) and to whom given]:_________________ 1 See Appendix A American LegalNet, Inc. www.FormsWorkFlow.com Form 7-10 page 3 APPENDIX A PERMISSIBLE TERMS AND CONDITIONS OF PROBATION [22 N.Y.C.R.R. §§205.66 (a),(b)] An order placing a juvenile on probation, pursuant to Section 757 of the Family Court Act, shall be reasonably related to the adjudicated acts or omissions of the Respondent and shall contain at least one of the following terms and conditions applicable to suspended judgments and at least one of the following additional terms and conditions of probation, directing the Respondent to: (a) Suspended Judgment and Probation Conditions 1. attend school regularly and obey all rules and regulations of the school; 2. obey all reasonable commands of the parent or other person legally responsible for the respondent's care; 3. avoid injurious or vicious activities; 4. abstain from associating with named individuals; 5. abstain from visiting designated places; 6. abstain from the use of alcoholic beverages, hallucinogenic drugs, habit forming drugs not lawfully prescribed for the respondent's use, or any other harmful or dangerous substance; 7. cooperate with a mental health or other appropriate community facility to which the respondent is referred; 8. make restitution or perform services for the public good; 9. restore property taken from the petitioner, complainant or victim, or replace property taken from the petitioner, complainant or victim, the cost of said replacement not to exceed $1,500; 10. repair any damage to, or defacement of, the property of the petitioner, complainant or victim, the cost of said repair not to exceed $1,500; 11. abstain from disruptive behavior in the home and in the community; 12. cooperate in accepting medical or psychiatric diagnosis and treatment, alcoholism or drug abuse treatment or counseling services, and permit an agency delivering that service to furnish the court with information concerning the diagnosis, treatment or counseling; 13. attend and complete an alcohol awareness program established pursuant to paragraph (6)(a) of subdivision (a) of section 19.07 of the mental hygiene law; 14. comply with such other reasonable terms and conditions as the court shall determine to be necessary or appropriate to ameliorate the conduct which gave rise to the filing of a petition. (b) Additional Conditions of Probation 1. meet with the assigned probation officer when directed to do so by that officer; 2. permit the assigned probation officer to visit the respondent at home or at school 3. permit the assigned probation officer to obtain information from any person or agency from whom the respondent is receiving or was directed to receive diagnosis, treatment or counseling; 4. permit the assigned probation officer to obtain information from the respondent's school; 5. cooperate with the assigned probation officer in seeking to obtain and in accepting employment and employment counseling services; 6. submit records and reports of earnings to the assigned probation officer when requested to do so by that officer; 7. obtain permission from the assigned probation officer for any absence from the county or residence in excess of two weeks; 8. attend and complete an alcohol awareness program established pursuant to paragraph (6)(a) of subdivision (a) of section 19.07 of the mental hygiene law; 9. do or refrain from doing any other specified act of omission or commission that, in the opinion of the court, is necessary and appropriate to implement or facilitate the order placing the respondent on probation. 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