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Petition (Termination Of Parental Rights - Mental Illness-Retardation) TPR-8 - New York
| Petition (Termination Of Parental Rights - Mental Illness-Retardation) Form. This is a New York form and can be used in Guardianship And Termination Of Parental Rights Family Court Statewide . |
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Soc. Serv. Law§§. 384-b, 384-c Form TPR-8 (Petition-Termination of Parental Rights Mental Illness or Mental Retardation of Parents) (8/2010) FAMILY COURT OF THE STATE OF NEW YORK COUNTY OF ......................................................................................... In the Matter of the Commitment of Guardianship and Custody pursuant to § 384-b of the Social Services Law of Docket No. PETITION TERMINATION OF PARENTAL RIGHTS - MENTAL ILLNESS MENTAL RETARDATION CIN # A Child under the Age of Eighteen Years, alleged to be the Child of Mentally Ill or Mentally Retarded Parents .......................................................................................... IF THIS PETITION IS GRANTED, YOU MAY LOSE YOUR RIGHTS TO YOUR CHILD AND YOUR CHILD MAY BE ADOPTED WITHOUT YOUR CONSENT AND WITHOUT NOTICE TO YOU. IF YOU ARE THE PARENT, FOSTER PARENT OR CUSTODIAN OF THE CHILD, YOU HAVE A RIGHT TO HAVE A LAWYER REPRESENT YOU. IF YOU CANNOT AFFORD A LAWYER, YOU MAY ASK THE COURT TO APPOINT A LAWYER TO REPRESENT YOU WITHOUT FEE. TO THE FAMILY COURT: The undersigned Petitioner(s) respectfully allege(s) that: 1. Petitioner(s) , (is) (are) an authorized agency having its office and place of business at [specify, including county]: foster parent(s) residing at [specify, including county]: child's attorney guardian ad litem filing at the Court's direction, pursuant to Social Services Law §384-b(3)(b). 2 a. is a male female child under the age of eighteen years, born on [specify]: , at [specify]: , who now resides at [specify, including county]: . b. The subject child is is not a Native-American child, who is subject to the Indian Child Welfare Act of 1978 (25 U.S.C. §§ 1901-1963). If so, the following have been notified [check applicable box(es)]: parent/custodian [specify name and give notification date]: tribe/nation [specify name and give notification date]: United States Secretary of the Interior [give notification date]: American LegalNet, Inc. www.FormsWorkFlow.com Form TPR-8 3. The full name and last-known address of each parent and custodian of the child are: Name Last-Known Address Page 2 4. a. The name and last-known address of any other interested party who should be afforded notice of this proceeding are: Name Last-Known Address b. The name and last-known address of any other person entitled to notice of an adoption pursuant to Domestic Relations Law § 111-a are: Name Last-Known Address c. There are no persons other than those set forth entitled to notice of this proceeding or of an adoption of the child. 5. The child was removed from his or her home on [specify]: and came into the care of an authorized agency on [specify]: , under the following circumstances: [include court, county, docket number and date(s) of prior proceedings]: The child has been in the care of an authorized agency for [check applicable box]: a continuous one year period immediately prior to the initiation of this proceeding 15 of the most recent 22 months. 6. (Upon information and belief) the of the child(ren) (is) (are) mentally ill mentally retarded as defined in Section 384-b of the Social Services Law in that [specify]: 7. By reason of the parent's mental illness mental retardation, the child would be in danger of becoming a neglected child as defined in the Family Court Act, if the child were placed in or returned to the custody of [specify]: in that [specify basis for statement]: . 8. The best interests of the child will be promoted by commitment of the guardianship and custody of the child to , an authorized agency foster parent(s), for the following reasons: [If appropriate, include facts regarding a non-respondent parent.] 9. The child is is not under the jurisdiction of the Family Court. If so, this petition [check box]: has has not been filed in the Court that exercised jurisdiction over the most recent permanency or other proceeding involving this child. [If it has not been so filed, petitioner must file affirmation, Form TPR-12]. 10. No previous application has been made to any court or judge for the relief sought herein (except American LegalNet, Inc. www.FormsWorkFlow.com Form TPR-8 ). Page 3 WHEREFORE, Petitioner(s) request(s) an order determining that the above-named child is a child whose parent(s) (is)(are) presently and for the foreseeable future unable by reason of mental illness mental retardation, as defined by section 384-b of the Social Services Law, to provide proper and adequate care, and committing the guardianship and custody to an authorized agency foster parent(s)), and for such other and further relief as in the interests of the child may be granted. Dated: Dated: . . Agency by: Name Title Foster parent: Print or type name Signature of Attorney, if any Attorney's Name (Print or Type) Attorney's Address and Telephone Number VERIFICATION (Agency) STATE OF NEW YORK COUNTY OF deposes and says: That (he) (she) is a duly constituted official of the above-named authorized agency, to wit, its ; That (he) (she) has read the foregoing Petition and knows the contents thereof; that the same is true to (his) (her) own knowledge except as to matters therein stated to be alleged on information and belief and that as to those matters (he) (she) believes it to be true. ) ss.: ) being duly sworn, Agency Official Sworn to before me this day of , . (Deputy) Clerk of the Court Notary Public American LegalNet, Inc. www.FormsWorkFlow.com Form TPR-8 VERIFICATION (Individual) STATE OF NEW YORK COUNTY OF ) )SS.: ) Page 4 , being duly sworn, says that (s)he is the Petitioner in the above-entitled proceeding and that the foregoing petition is true to (his) (her) own knowledge, except as to matters herein stated to be alleged on information and belief and as to those matters (s)he believes it to be true. Petitioner Sworn to before me this day of . (Deputy) Clerk of the Court Notary Public American LegalNet, Inc. www.FormsWorkFlow.com
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