DRL Art. 5-A Form UCCJEA-2 (Order on Petition for Custody or Visitation ­ UCCJEA) (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 Proceeding for Custody Visitation under the Uniform Child Custody Jurisdiction and Enforcement Act Petitioner Docket No. FINAL ORDER TEMPORARY ORDER ON PETITION FOR CUSTODY VISITATION ­ UCCJEA -againstRespondent ....................................................................................... The Petitioner herein having filed a petition on [specify date]: , , pursuant to the Uniform Child Custody Jurisdiction and Enforcement Act [Article 5-A of the Domestic Relations Law], requesting an order of custody visitation of the following minor children [list each child as follows]: Name of Child: Date of Birth: Address1 ; and Respondent having appeared not appeared before this Court, either in person or by telephone, audiovisual or other electronic means, to answer the petition, having been advised by the Court of the right to counsel, and Respondent having denied admitted the allegations of the petition; and [Required in cases involving Native-American children, where government agency is a party; check if applicable]: And the following having been duly notified [check applicable box(es)]: parent/custodian tribe/nation United States Secretary of the Interior; And the tribe/nation having: appeared and participated as a party; appeared and declined to assume jurisdiction; appeared and requested transfer of jurisdiction; 1. Unless the Court has ordered the address to be confidential on the ground that disclosure would pose an unreasonable health or safety risk. See Family Court Act §154-b; Domestic Relations Law §§76-h(5), 254; Form 21 (available at www.nycourts.gov). American LegalNet, Inc. www.FormsWorkFlow.com 1 Form UCCJEA-2 not appeared; Page 2 [Check applicable box(es)]: And the Court having searched the statewide registry of orders of protection, the sex offender registry and the Family Court's warrant and child protective records, and having notified the attorneys for the parties and for the child [check if applicable]: and the following self-represented party or parties [specify]: of the results of these searches; And the Court having considered and relied upon the following results of these searches in making this decision [specify; if no results found, so indicate]: [Applicable to TEMPORARY orders only]: And the Court, having dispensed with the search of the statewide registry of orders of protection, the sex offender registry and the Family Court's warrant and child protective records because these databases had been reviewed within the past 90 days; [Applicable where a party had made an allegation of domestic violence or child abuse; findings must be stated on the record, included in a written decision OR included in this order; check applicable box]: And the Court having explained its findings on alleged domestic violence or child abuse on the record; And the Court having issued a written decision containing its findings on alleged domestic violence or child abuse; And the Court having found that the allegation that [specify party]: had committed domestic violence or child abuse against [specify party or child(ren)]: was was not proven by a preponderance of the evidence, and having considered the effect of such domestic violence or child abuse upon the best interests of the child(ren) and relevant facts and circumstances as follows in making this order [specify how findings, facts and circumstances were factored into this Order]: [Applicable to cases where Petitioner is a relative or other non-parent and where hearing was consolidated with a New York child protective dispositional or permanency hearing, pursuant to F.C.A. §§1055-b or 1089-a; DELETE IF INAPPLICABLE]: And the Court having found that: Termination of the order placing or remanding the child(ren) pursuant to Article 10 or 10-A of the Family Court Act will will not not jeopardize the child(ren)'s safety and is is not in the best interests of the child(ren). The child(ren)'s birth mother has has not consented to the award of custody to the Petitioner. If not, the following extraordinary circumstances support Petitioner's standing to seek custody of the child(ren) [specify]: The child's legally-established birth father has has not consented to the award of custody to the Petitioner. If not, the following extraordinary circumstances support Petitioner's standing to seek custody of the child(ren) [specify]: The child has been living with the following foster parent(s)[specify]: for a period in excess of one year, who G has/have G has/have not consented to the award of custody to the Petitioner. American LegalNet, Inc. www.FormsWorkFlow.com Form UCCJEA-2 Page 3 The local department of social services, the petitioner in the related child abuse or neglect permanency proceeding has has not consented to the award of custody to the Petitioner. The attorney for the child(ren) [specify]: in the related child abuse or neglect permanency proceeding has has not consented to the award of custody to the Petitioner. And this Court further finds and determines that [specify]: The matter having duly come on to be heard before this Court; NOW, after examination and inquiry into the facts and circumstances of the case and after hearing the proofs and testimony offered in relation thereto; it is hereby ADJUDGED that [check applicable box(es)]: 1. This Court has jurisdiction to issue a child custody or visitation order pursuant to Section 76(1) of the Domestic Relations Law on the following grounds [check all applicable box(es)]: a. this state was the home state of the child on the date of the filing of this petition; this state was the home state of the child within six months before the filing of this petition; and the child is absent from this state but a parent or person acting as a parent continues to live in this state; OR b. the child and the child's parents, or the child and at least one parent or a person acting as a parent, have a significant connection with this state other than mere physical presence; and substantial evidence is available in this state concerning the child's care, protection, training, and personal relationships; and EITHER [check applicable box]: a court of another state does not hav