Application For Return Of Child Temporarily Removed From Home
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1F.C.A. §1028
Form 10-4
(Child Protective – Application for Return
of Child Temporarily Removed from Home)
(9/2006)
FAMILY COURT OF THE STATE OF NEW YORK
COUNTY OF
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In the Matter of
Docket No.
CIN #
Application for Return of
Child Temporarily Removed
(A) Child(ren) under the Age of Eighteen years
From Home
Alleged to be Abused Neglected by
Respondent(s)
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TO THE FAMILY COURT:
1. I am the Respondent
Law Guardian in the above-entitled proceeding.
2. The following child(ren)[specify]:
(was)(were)
temporarily removed from the place where the child(ren) resided on [specify date]:
The child(ren) were removed [check box]:
by order of the Family Court, dated [specify]:
upon the Respondent’s written consent;
on an emergency basis without a court order.
3. A petition has
has not been filed under Section 1031 of the Family Court Act.
4. No previous application has been made to any court or judge for the relief requested
herein, (except)[specify]:
WHEREFORE, I respectfully request a hearing regarding the return of the child(ren).
Dated:
Respondent
____________________________________
Respondent’s Address, Telephone No.
_____________________________________
Attorney for Respondent
_____________________________________
Attorney’s Address, Telephone No.
Law Guardian
_____________________________________
Law Guardian’s Address, Telephone No.
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