New York Codes, Rules and Regulations
Title 22 - JUDICIARY
Subtitle D - Forms
Chapter IV - Forms of the Family Court of the State of New York and Adoption Forms of the Family Court of the State of New York (cf. s205.7)
Subchapter A - Forms Authorized by Section 205.7
Surrender Forms
Form SURR-1 - Notice of proceeding for approval of judicial or extra-judicial surrender instrument
S.S.L. §§ 383-c, 384, 384-c Form SURR-1
(Surrender--Notice of Proceeding for
FAMILY COURT OF THE STATE OF NEW YORK Approval of Judicial or Extra-judicial
COUNTY OF Surrender Instrument)
(9/2006)
In the Matter of the Application for Approval Docket No.
of a Surrender Instrument Pursuant to Sections
383-c or 384 of the Social Services Law Concerning NOTICE OF PROCEEDING FOR
APPROVAL OF
CIN# JUDICIAL EXTRA-JUDICIAL
Child's Name: SURRENDER INSTRUMENT
Date of Birth:
TO:
PLEASE TAKE NOTICE that the annexed petition requesting approval of an instrument of surrender concerning the above-named child has been presented to the Family Court of the State of New York, County, located at [specify address]: and that a hearing on the petition will be held on [specify date and time]: at which time you will have an opportunity to be heard.
PLEASE TAKE FURTHER NOTICE that you have the right to be represented by a lawyer and, if you are a custodial or non-custodial parent, guardian, grandparent, foster parent or other person having physical or legal custody of the above-named child and the Court finds that you are unable to pay for a lawyer, you have the right to have a lawyer assigned by the Court.
FAILURE TO APPEAR MAY RESULT, WITHOUT FURTHER NOTICE, IN COURT APPROVAL OF THE SURRENDER INSTRUMENT AND TRANSFER OF CUSTODY AND GUARDIANSHIP OF THE CHILD TO A SOCIAL SERVICES OFFICIAL OR AUTHORIZED AGENCY FOR THE PURPOSE OF ADOPTION.
NOTICE TO ADJUDICATED, ACKNOWLEDGED OR IDENTIFIED FATHERS, pursuant to Social Services Law § 384-c:[FN1] You have a right to appear to present evidence to the Family Court relevant to the best interests of the child. Your failure to appear will be considered a denial of your interest in the child and may result, without further notice, in court approval of the surrender instrument and transfer of custody and guardianship of the child to a social services official or authorized agency for the purposes of adoption.
Dated:
_______________
Name of Attorney(s)
_______________
Attorney(s) for Petitioner:
_______________
Mailing Address
_______________
Telephone Number
[FN1] This notice paragraph applies to you IF you have: (i) been adjudicated the father by a court in New York State; (ii) been adjudicated the father elsewhere by a court order that has been filed with the national putative father registry; (iii) filed a timely notice of intent to claim paternity and have not revoked it; (iv) been identified as the father in the child's birth certificate or in a sworn written statement by the child's mother; (v) been openly living with the child's mother as the child's parent when the court proceeding was begun or the child was placed with the authorized agency; (vi) been married to the child's mother within six months after the child's birth and before execution of the surrender instrument; or (vii) filed an acknowledgment of paternity with the national putative father registry.
