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Affidavit In Support Of Motion To Terminate Placement 10-11b - New York
| Affidavit In Support Of Motion To Terminate Placement Form. This is a New York form and can be used in Child Protective Family Court Statewide . |
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F.C.A.ยง1062 Form 10-11b (Child Protective- Affidavit in Support of Motion To Terminate Placement) (9/2005) FAMILY COURT OF THE STATE OF NEW YORK COUNTY OF ....................................................................................... In the Matter of Docket No. A Child under Eighteen Years of Age alleged to be Abused Neglected by AFFIDAVIT IN SUPPORT OF MOTION TO TERMINATE PLACEMENT Respondent(s) ....................................................................................... STATE OF NEW YORK ) ) SS.: COUNTY OF NEW YORK ) , swears the following to be true under the penalties of perjury: 1. I am the parent other interested person [specify relationship to child]: of [specify child]: . I am making this affidavit in support of the motion to terminate the child's placement. 2. (Upon information and belief,) the above-named child, was removed from (his)(her) home on [specify date]: and was placed in foster care on [specify date]: , as a result of a proceeding under Article 10 of the Family Court Act. Custody of the child remains with [specify]: 3. I made a request to [specify social services or agency official]: child's placement and return the child to my home on [specify date]: That request was denied on [specify date]: not granted within 30 days of my request. to terminate the . 4. The child's placement should be terminated and the child should be returned to my home for the following reasons [specify]: 5. No previous application has been made to any court or judge for this relief (except [specify]: American LegalNet, Inc. www.USCourtForms.com Form 10-11b Page 2 ). WHEREFORE, I respectfully request that an Order be made herein terminating the placement of the above-named child, returning the child to my home and granting such other and further relief as the Court may deem just and proper. Affiant Sworn to before me this day of , (Deputy) Clerk of the Court Notary Public American LegalNet, Inc. www.USCourtForms.com
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