DRL Art. 5-A Form UCCJEA-10 (Order on Petition to Modify Custody or Visitation Order – UCCJEA), (9/2008) 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 to Modify a “ Custody “ Visitation Order under the Uniform Child Custody Jurisdiction and Enforcement Act Docket No. Petitioner ORDER ON PETITION TO MODIFY ORDER OF “ CUSTODY “ VISITATION – UCCJEA -against- Respondent ....................................................................................... The Petitioner herein having filed a petition on [specify date]: , pursuant to the Uniform Child Custody Jurisdiction and Enforcement Act [Domestic Relations Law Art. 5-A], requesting an order modifying 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 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 having “ admitted “ denied the allegations of the petition; [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; 1 Unless the Court has ordered the address to be kept confidential pursuant to New York State Domestic Relations Law §§76-h(5), 254 or Family Court Act §154-b. . American LegalNet, Inc. www.FormsWorkflow.com Form UCCJEA-10 Page 2 “ appeared and declined to assume jurisdiction; “ appeared and requested transfer of jurisdiction; “ not appeared; And 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 modify the child custody or visitation order issued by [specify state or other jurisdiction, index or docket number and date]: on the following grounds [check applicable box(es)]: “ This Court has jurisdiction to make an initial determination of custody or visitation and [check at least one box]: “ the court of the other state has determined that it no longer has exclusive, continuing jurisdiction; “ the court of the other state has determined that a court of this State would be a more convenient forum; “ a court of the other state has determined that the child, the child’s parents and any other person acting as a parent do not presently reside in the other state; “ a court of New York State has determined that the child, the child’s parents and any other person acting as a parent do not presently reside in the other state; “ This Court has determined that the other state no longer has exclusive continuing jurisdiction and this Court has jurisdiction to modify the order because [check applicable box(es)]: “ Neither the child, the child’s parents nor any other person acting as a parent presently reside in the other state; “ New York State has been the home state of the child for at least six months as of the date of this order; “ New York State would be a more convenient forum based upon the following factors [specify]: OR “ This Court does not have jurisdiction to modify the order. 2. [Applicable where temporary, emergency order is issued]: “ This Court has jurisdiction to modify the 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 therefore ORDERED that [check applicable box]: “ The Petition to Modify is GRANTED and the order of custody or visitation shall be modified as follows [specify]: American LegalNet, Inc. www.FormsWorkflow.com Form UCCJEA-10 Page 3 “ The Petition to Modify is GRANTED solely on a temporary, emergency basis as follows [specify]: This temporary, emergency order shall remain in effect until an order is obtained from another court having jurisdiction to modify the order of custody or visitation pursuant to Section 76-b of the Domestic Relations Law. 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 to modify the order of custody or visitation pursuant to DRL §76-b. [Check box if applicable]: “ Because the child(ren) is/are in imminent risk of harm, this order shall remain in effect until another court having jurisdiction to modify the order of custody or visitation pursuant to Domestic Relations Law §76-b has taken steps to assure the protection of the child(ren). OR “ The Petition to Modify 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; and it is further ORDERED that the Respondent pay the Petitioner the following fees and costs in connection with this proceeding [specify]: ; and it is further [Applicable in cases involving Native-American child(ren) where government agency is a party; check box, if applicable]: “ 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 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 LAW GUARDIAN UPON THE APPELLANT, WHICHEVER 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