N.Y. Comp. Codes R. & Regs. tit. 22, subtit. D, ch. IV, subch. A, Person in Need of Supervision (Family Court Act Article 7), form 7-11 - Discontinuance of treatment

Secs. 756, 771, 772 F.C.A. Form 7-11

(Person in Need of Supervision)

7/83

________

In the Matter of Docket No. ________

________ PETITION

A Person Alleged to Be a Person In

Need of Supervision, (Discontinuance of

Treatment)

________ Respondent.

________

TO THE FAMILY COURT:

The undersigned Petitioner respectfully alleges that:

1. Petitioner, ________, is an authorized agency with which the above-named respondent has been placed by Order of this Court dated ________, 19 ________, pursuant to section 756 of the Family Court Act.

2. Petitioner (has discontinued or suspended its work in that: [state facts]

____________

____________)

(is unwilling to care for the above-named respondent for the reason that support by (the State of New York) (________, one of its political subdivisions) has been discontinued in that: [state facts]

____________

____________)

(has fundamentally altered its program and as a result the above-named respondent can no longer benefit from it, in that: [state facts]

____________

____________).

3. No previous application has been made to any court or judge for the relief herein requested (except

____________

____________).

WHEREFORE, petitioner prays that an Order be made and entered returning respondent to this Court for such further or other disposition as to the Court may seem just and proper.

______________

Petitioner

By:________

______________

(Title)

VERIFICATION

(Agency)

STATE OF NEW YORK)

) ss.:

COUNTY OF)

________, being duly sworn, deposes and says:

That (s)he is the ________ of ________, an agency authorized to originate the above-entitled proceeding, and is acquainted with the facts and circumstances therein; that (s)he has read the foregoing 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 as to those matters (s)he believes it to be true.

______________

Name

______________

Title

Sworn to before me this

________ day of ________, 19________.

______________

Notary Public

Notes

N.Y. Comp. Codes R. & Regs. tit. 22, subtit. D, ch. IV, subch. A, Person in Need of Supervision (Family Court Act Article 7), form 7-11