Printing Specifications Statement Pursuant To 22 NYCRR 1250.8 (j)

STATE OF NEW YORK FAMILY COURT:__________________ COUNTY ___________________________________________ In the Matter of , A Person Alleged to be a Person In Need of Supervision, Respondent. ___________________________________________ STATE OF NEW YORK COUNTY OF TOWN OF ) ) SS: ) STIPULATION DISCONTINUING APPEAL Docket No. IT IS HEREBY STIPULATED AND AGREED, by and between the undersigned, the attorneys of record for all the parties to the above-entitled action, that no person not a party has an interest in the subject matter of the action, the Respondent's appeal in the above-entitled action be, and the same hereby is discontinued, without costs to either party as against the other. This stipulation may be filed without further notice with the Clerk of the Court. Dated:_________________________ , ESQ. Attorney for Respondent Assistant County Attorney , ESQ. On the ____ day of , in the year 20__, before me, the undersigned, a notary public in and for said state, personally appeared ______________________, personally known to me or proved to me on the basis of satisfactory evidence to be the individual whose name is subscribed to the within instrument and acknowledged to me that he executed the same in his capacity, and that by his signature on the instrument, the individual, or the person upon behalf of which the individual acted, executed the instrument. Notary Public American LegalNet, Inc. www.FormsWorkFlow.com