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Petition (For Custody And Or Visitation) GF-17 - New York
| Petition (For Custody And Or Visitation) Form. This is a New York form and can be used in General Family Court Statewide . |
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FC A 467, 549, 651, 652,654; DR L 240 General Form 17 (Petition-Custody, Visitation) 10/2004 FAM ILY COURT OF THE STAT E OF NEW YORK COUNT Y OF ........................................................................ ............. In The Matter of a Proceeding for 9Custody 9Visitation under Article 94 95 96 1 of the Family Court Act or Section 240 of the Domestic Relations Law Petitioner Docket No. PETITION CUSTODY VISITATION -against- R espondent ........................................................................ ............... TO THE FAM ILY C OURT: The undersigned Petitioner respectfully alleges upon information and belief that: 1. Petitioner, , [check applicable box]: resides is located at[specify address or indicate if ordered to be kept confidential pursuant to Family Court Act 154- b(2) or Domestic Relations Law 254]: Petitioner is [specify relationship to child; if foster parent, agency, institution or other relationship, so state]: 2. Respondent , , [check applicable box]: resides is located at[specify address or indicate if ordered to be confidential, pursuant to Family Court Act 154-b(2) or Domestic Relations Law 254]: R espondent is [specify relationship to child; if foster parent, agency, institution or other relationship, so state]: 1 Note: If a custody or visitation proceeding is pending or an order of custody or visitation has been issued by a court outside of the State of New York, the custody/visitation petition for proceedings under the Uniform Child Custody Jurisdiction and Enforcement Act, Form UCCJEA-1, not this form, should be utilized. American LegalNet, Inc. www.USCourtForms.com<<<<<<<<<********>>>>>>>>>>>>> 2 General Form 17 Page 2 3. [Delete if inapplicable]: An order was issued by Court, County, State of , referring the issue of custody visitation to the Family Courtof the State of New York in and for the County of [specify]: 4. The name, present address and date of birth of each child who is the subject of this proceeding are as follows [specif y address or indicate if ordered to be kept confidential pursuant to Family Court Act 154-b(2) or Domestic Relations L aw 254]: Name A ddress Date of Birth 5. (Upon information and belief) During the last five years each child who is the subject of this proceeding resided at: 2 Name Address Duration (from/to) 6. (Upon information and belief) The name and present address of the person(s) with whom each child resided during the past five years are as follows; 3 Name Address Duration (from/to) 7. [Check applicable box(es). Delete inapplicable provisions]: a. G The father of the child(ren) who (is)(are) the subject(s) of this proceeding is [specify]: . G The father was married to the child(ren)s mother at the time of the conception or birth. G An order of filiation was made on [specify date and court and attach true copy]: G An acknowledgment of paternity was signed on [specify date]: by [specify who signed and a t t ac h a t r u e c o p y ] : G The father is deceased. b. G The father of the child(ren) who (is)(are) the subject(s) of this proceeding has not been legally established. c. G A paternity agreement or compromise was approved by the Family Court of 2 Specify address or indicate if ordered to be kept confidential pursuant to Family Court Act 154-b(2) or Domestic Relations Law 254. 3 Specify address or indicate if ordered to be kept confidential pursuant to Family Court Act 154-b(2) or Domestic Relations Law 254. American LegalNet, Inc. www.USCourtForms.com<<<<<<<<<********>>>>>>>>>>>>> 3 General Form 17 Page 3 County on , , concerning [name parties to agreement or compromise and child(ren)] : A true copy of theagreement or compromise is annexed hereto. 8. [A pplicable to cases in which mother is not a party] : The name and address of the mother is [indicate if deceased or if address ordered to be kept confidential pursuant to Family Court Act 154-b(2) or Domestic Relations Law 254]: 9. [Delete if inapplicable]: Petitioner has participated as a G party G witness G other capacity [specify] : in other litigation concerning the custody of the same children in G New York State G Other jurisdiction [specify]: If so, specify type of case, capacity of participation, court, location and status of case. 10. A custody or visitation proceeding concerning the same child(ren) G is G is not pending in New York State. [If pending, give court docket number and status of case]: 11. The custody or visitation of the child(ren) has been determined or agreed upon in the following instruments [specify court, if any, and date and attach true copy of instrument(s)]: G Custody order of [specify court and location]: , dated [specify]: G Stipulation of settlement in [specify court and location]: , dated [specify]: G Judgment of Divorce of [specify court and location]: , dated [specify]: G Separation Agreement, dated [specify]: G Custody or Guardianship Agreement confirmed by [specify court and location]: , dated [specify]: 12. G Petitioner G Respondent obtained custody of the child(ren) on [specify date]: , as follows: 13. It would be in the best interests of the child(ren) to have G custody G visitation awarded to the Petitioner for the following reasons: 14. There has been a change of circumstances since entry of the G order G judgment awarding G custody G visitation in that: 15. An Order of Protection or Temporary Order of Protection was issued [check applicable box(es]: Q against Respondent Q against me in the following criminal, American LegalNet, Inc. www.USCourtForms.com<<<<<<<<<********>>>>>>>>>>>>> 4 General Form 17 Page 4 matrimonial or Family Court proceeding(s) [specify the court, docket or index number, date of order, next court date and status of case, if available]: The Q Order of Protection Q Temporary Order of Protection expired or will expire on [specify date ]: 16. Petitioner requests a Temporary Order of Protection pursuant to Family Court Act 655 because [specify]: 17. The subject child(ren) are are not Native-A merican child(ren) subject to the Indian Child Welfare Act of 1978 (25 U.S .C. 1901-1963). 18. No previous application has been made to any court or judge for the relief herein requested, (except [specify; delete if inapplicable]: ) WHER EFOR E, Petitioner requests an order awarding Q custody Q visitation of the child(ren) to the Petitioner and for such other and further relief as the Court may determine. Dated: _______ __________________ Petitioner _________________________ Print or Type Name
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