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 B - Adoption Forms Of The Family Court
Adoption Forms
Form 1-E - Affirmation regarding venue
D.R.L. § 113 Adoption Form 1-E
[This form must be submitted (Affirmation Regarding Venue) in cases where the adoption petition was filed before (9/2006) a judge other than the judge who heard the most recent Family Court proceeding]
FAMILY COURT OF THE STATE OF NEW YORK
COUNTY OF
________
In the Matter of the Adoption of Docket No.
A Child Whose First Name Is: AFFIRMATION
REGARDING VENUE
________
I, [specify name]: , , an attorney duly admitted to practice law in the State of New York, affirm the following:
1. I represent [specify]: , the prospective adoptive parents in the above-entitled proceeding regarding the adoption of [specify child's first name]:
2. Upon information and belief, according to [specify agency having custody or guardianship of child or other source of information]:
the child was freed for adoption as follows [check applicable box(es)]:
a. The child's birth mother:
surrendered her parental rights in a judicial surrender executed before Judge [specify]: in Family Court, [specify county]: on [specify date]: in Docket # [specify]:
extra-judicial surrender approved by Judge [specify]: in Family Court, [specify county]: on [specify date]: in Docket # [specify]:
had her parental rights terminated by order of Judge [specify]: in Family Court, [specify county]: on [specify date]: in Docket # [specify]:
is unknown.
is deceased.
b. The child's birth father or any other individual entitled to consent to the adoption:
surrendered his parental rights in a judicial surrender executed before Judge [specify]: in Family Court, [specify county]: on [specify date]: in Docket # [specify]:
extra-judicial surrender approved by Judge [specify]: in Family Court, [specify county]: on [specify date]: in Docket # [specify]:
had his parental rights terminated by order of Judge [specify]: in Family Court, [specify county]: on [specify date]: in Docket # [specify]:
is unknown.
is deceased.
Adoption Form 1-E Page 2
3. Upon information and belief, according to [specify agency having custody or guardianship of child or other source of information]: the child's most recent permanency hearing was held before [specify judge or referee] in Family Court, [specify county]: , on [specify date]:
4. This adoption proceeding has been filed before this Court for the following reasons [check applicable box(es) and explain]:
This Court is more familiar with the facts and circumstances regarding permanency planning for, and the needs and best interests of, this child, because [specify]:
The child's law guardian [specify]: is able to continue to represent the child in this proceeding.
The prospective adoptive parents reside in [specify county] and would find it inconvenient to travel to the Family Court in [specify county]:
This Court will be able to proceed in this matter more expeditiously because [specify]:
Other [specify]:
WHEREFORE, for the reasons stated above, I am requesting that this Court retain jurisdiction over this adoption proceeding.
______________
Signature of Affirmant
______________
Affirmant's Name (print or type)
________
________
______________
Affirmant's Address and Telephone Number
