DRL Art. 5-A Form UCCJEA-2 (Order on Petition for Custody or Visitation – UCCJEA) (3/2009) 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. 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; “ not appeared; 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 American LegalNet, Inc. (available at www.nycourts.gov). www.FormsWorkflow.com Form UCCJEA-2 Page 2 [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 10A 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 has/have has/have not consented to the award of custody to the Petitioner. 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]: child abuse or neglect permanency proceeding custody to the Petitioner. has in the related has not consented to the award of 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 American LegalNet, Inc. www.FormsWorkflow.com Form UCCJEA-2 [check applicable box]: c.“ Page 3 “ a court of another state does not have home state jurisdiction under paragraph (a); OR “ a court of the home state of the child has declined to exercise jurisdiction on the ground that this state is the more appropriate forum under Domestic Relations Law §§76-f or 76-g, because [specify]: OR all courts having jurisdiction under paragraph (a) or (b) of this subdivision have declined to exercise jurisdiction on the ground that a court of this state is the more appropriate forum to determine the custody of the child under Domestic Relations Law §§76-f or 76g, because [specify]: OR d.“ no court of any other state would have jurisdiction under the criteria specified in paragraph (a), (b) or (c). OR “ This Court does NOT have jurisdiction to make an initial determination of custody or visitation pursuant to Section 76(1) of the Domestic Relations Law. 2. [Check box if applicable]: “ This Court has jurisdiction to issue an order on a temporary, emergency basis, pursuant to Domestic Relations Law §76-c, because the child is presently in this State and [check one or both boxes]: “ the child has been abandoned; and/or “ it is necessary in an emergency to protect the child, a sibling or parent of the child. 3. Petitioner incurred the following attorneys’ fees and expenses in prosecuting this action [specify]: AND IT IS HEREBY ORDERED that [check applicable box(es)]: “ The Petition for “ custody “ visitation is GRANTED as follows [specify]: OR “ The Petition for “ custody “ visitation is GRANTED solely on a temporary, emergency basis as follows [specify]: This order shall remain in effect until an order is obtained from another court having jurisdiction pursuant to Sections 76 through 76-b of the Domestic Relations Law. Where the child(ren) is/are in imminent risk of harm, this order shall remain in effect until another court having jurisdiction pursuant to DRL §76 through §76-b has taken steps to assure the protection of the child(ren). This temporary, emergency order shall become final if this State becomes the home state of the child(ren) and if no child custody proceeding is commenced in a state having jurisdiction pursuant to DRL §76 through §76b. OR “ The Petition is DENIED and is hereby dismissed. This dismissal is without prejudice to any remedies, if any, that Petitioner may have in another state or other jurisdiction. American LegalNet, Inc. ; and it is further www.FormsWorkflow.com Form UCCJEA-2 Page 4 ORDERED that the Respondent pay the Petitioner the following fees and costs in connection with this proceeding [specify]: ; and it is further [Applicable to cases involving a party or parties in the military; DELETE IF INAPPLICABLE]: ORDERED that, since “ Petitioner “Respondent is on active duty, deployed or temporarily assigned to military service and since such service affects such party’s ability to act as a joint or primary custodian of the child(ren), this Order is to be deemed temporary so as to entitle either party upon request to reopen these proceedings upon the completion of the period of active military service, deployment or temporary assignment for the court to determine whether a change in circumstances has occurred sufficient to support modification of this Order; and it is further ORDERED that during the period of active military service, deployment or temporary assignment, the party on such duty shall be permitted the following contact and visitation with the child [specify, including electronic communication and visitation during military leaves]: ; and it is further [Applicable to cases where hearing was consolidated with child protective dispositional or permanency hearing, pursuant to F.C.A. §§1055-b or 1089-a; DELETE IF INAPPLICABLE]: ORDERED that the following local department of social services [specify]: and the following attorney for the child(ren)[specify]: shall be notified and shall be made parties to any subsequent proceedings for modification, enforcement or termination of the Order; and it is further [Applicable in cases involving Native-American child(ren) where government agency is a party; DELETE IF INAPPLICABLE]: “ ORDERED that the following should be notified of this proceeding [specify]: the “ custodian of the child; “ tribe/nation; “ United States Secretary of the Interior “ ORDERED that in light of the assumption of jurisdiction by the tribe/nation, this petition is DISMISSED WITHOUT PREJUDICE; (and it is further) ORDERED that ENTER _____________________________________ Judge of the Family Court Dated: . PURSUANT TO SECTION 1113 OF THE FAMILY COURT ACT, AN APPEAL FROM THIS ORDER MUST BE TAKEN W ITHIN 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 CHILD’S ATTORNEY UPON THE APPELLANT, W HICHEVER IS EARLIEST. 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]:_____________________ American LegalNet, Inc. www.FormsWorkflow.com