F.C.A.§§1027-a, 1081 Form GF-17c (Affidavit of Attorney for Child in Support of Motion for an Order for Sibling Placement or Contact) (2/2017) FAMILY COURT OF THE STATE OF NEW YORK COUNTY OF ....................................................................................... In the Matter of Docket No. AFFIDAVIT OF ATTORNEY FOR THE CHILD IN SUPPORT OF MOTION FOR ORDER FOR SIBLING CIN #: PLACEMENT OR CONTACT A Child under Eighteen Years of Age alleged to be ❑Abused ❑Neglected by Respondent(s) ....................................................................................... STATE OF NEW YORK ) ) SS.: COUNTY OF NEW YORK ) I, [name]: affirms the following to be true under the penalties of perjury: □ swears □ 1. I am the attorney for the following child(ren) [specify]: alleged to be in □ need of protection in the above-entitled action. the attorney for a sibling of the following child(ren) [specify]: , who □ is/are alleged to be in need of protection in the above-entitled action. I am making this affidavit in support of the motion for an Order to place my client with or provide contact with the following sibling(s): 2. a. My client is/are living with [specify]: b. My sibling(s) is/are living with [specify]: client’s 3. The agency has provided my client with contact with his/her sibling(s) as follows □ [specify]: provided my client with contact with his/her sibling(s). □has not
F.C.A.§§1027-a, 1081 Form GF-17c (Affidavit of Attorney for Child in Support of Motion for an Order for Sibling Placement or Contact) (2/2017) FAMILY COURT OF THE STATE OF NEW YORK COUNTY OF ....................................................................................... In the Matter of Docket No. AFFIDAVIT OF ATTORNEY FOR THE CHILD IN SUPPORT OF MOTION FOR ORDER FOR SIBLING CIN #: PLACEMENT OR CONTACT A Child under Eighteen Years of Age alleged to be ❑Abused ❑Neglected by Respondent(s) ....................................................................................... STATE OF NEW YORK ) ) SS.: COUNTY OF NEW YORK ) I, [name]: □ swears □ affirms the following to be true under the penalties of perjury: 1. I am □ the attorney for the following child(ren) [specify]: alleged to be in need of protection in the above-entitled action. □ the attorney for a sibling of the following child(ren) [specify]: , who is/are alleged to be in need of protection in the above-entitled action. I am making this affidavit in support of the motion for an Order to place my client with or provide contact with the following sibling(s): 2. a. My client is/are living with [specify]: b. My client’s sibling(s) is/are living with [specify]: 3. The agency □ has provided my client with contact with his/her sibling(s) as follows [specify]: □has not provided my client with contact with his/her sibling(s).