Fillable Page 1 of 12 F.C.A. 661 Form 6-1 (NYS Unified Court System Division of Technology)

Fill Online, Printable, Fillable, Blank Page 1 of 12 F.C.A. 661 Form 6-1 (NYS Unified Court System Division of Technology) Form

Use Fill to complete blank online NYS UNIFIED COURT SYSTEM DIVISION OF TECHNOLOGY (NY) pdf forms for free. Once completed you can sign your fillable form or send for signing. All forms are printable and downloadable.

Page 1 of 12 F.C.A. 661 Form 6-1 (NYS Unified Court System Division of Technology)

On average this form takes 43 minutes to complete

The Page 1 of 12 F.C.A. 661 Form 6-1 (NYS Unified Court System Division of Technology) form is 17 pages long and contains:

  • 0 signatures
  • 10 check-boxes
  • 169 other fields

Country of origin: US
File type: PDF

U.S.A. forms for NYS Unified Court System Division of Technology

BROWSE NYS UNIFIED COURT SYSTEM DIVISION OF TECHNOLOGY (NY) FORMS

Related forms
Fill has a huge library of thousands of forms all set up to be filled in easily and signed.
Fill in your chosen form
Sign the form using our drawing tool
Send to someone else to fill in and sign.
find another form
 
Page 1 of 12
F.C.A. § 661 Form 6-1
S.C.P.A. §§ 1701-1704 Appointment as Guardian
of a Person
3/2009
NCFC 3/2015
FAMILY COURT OF THE STATE OF NEW YORK
COUNTY OF NASSAU
..............................................................................
Proceeding for the Appointment of a Guardian of PETITION for Appointment as
the Person of Guardian of a Person
,
First M.I. Last
A Person Under the Age of 21
...............................................................................
TO THE FAMILY COURT:
The petitioner respectfully alleges to this court that:
1. I(We) am(are) submitting this petition in order to be appointed guardian of ,
a person under the age of 21, who is “the subject” of this petition.
2. Petitioner (1) - Information: Petitioner (2) - Information, if applicable:
Name: Name:
Date of Birth: Date of Birth:
*Address: *Address:
Relationship to the subject: Relationship to the subject:
*If address is not known to the party(ies) in section 7, and you are requesting that your address be
kept confidential, print the word CONFIDENTIAL above and print your address on the NCFC
Information Sheet only.
3. The person under the age of 21, who is the subject of this petition - Information:
Name:
Date of Birth:
Sex: G Male G Female
FILE #
DOCKET #
(Court use only)
Page 2 of 12
**Address:
G A certified copy of the birth certificate is attached.
**If address is not known to the party(ies) in section 7, and you are requesting that the subject’s
address be kept confidential, print the word CONFIDENTIAL above and print the subject’s address
on the NCFC Information Sheet only.
4. Is the subject of this petition a Native American child subject to the Indian Child Welfare Act of 1978
(25 U.S.C. § § 1901-1963)?
G Yes G No
If no, skip this section and go to number 5.
If yes, the parent(s) and/or custodian(s) and the tribe/nation are all required to be notified of this
petition. Specify the names and the dates of the notification. If any of this information is unknown,
the United States Secretary of the Interior is required to be notified of this petition. Specify the date
of the notification.
Name of the parent(s):
Date of notification:
Name of the custodian(s):
Date of notification:
Name of the tribe/nation:
Date of notification:
United States Secretary of the Interior:
Date of notification:
5. The name(s) and relationship(s) of the person(s) with whom the subject of this petition resides:
Name(s):
Relationship(s) to the subject:
6. Upon information and belief, the religion of the subject of this petition is .
Page 3 of 12
7. Fill in the following information completely. If the information is unknown, print the word UNKNOWN
under the Name column. If the information does not apply, print N/A under the Name column.
Relationship Name *Address Deceased?
Yes/No
7a. Birth mother:
7b. Birth father:
Paternity established:
G Yes G No G Unknown
7c. Person with whom the subject
resides, if other than the parents or
petitioner:
7d. Adult next of kin, if birth
parents are deceased:
7e. Person who has adopted or
received legal guardianship or
custody of the subject:
*If address is not known to the other party(ies) in this section, and you are requesting that the
address be kept confidential, print the word CONFIDENTIAL above and print the party’s address on
the NCFC Information Sheet only.
8a. State why you, the petitioner(s), should be appointed the guardian of the subject of this petition:
8b. State why this would be in the best interest of the subject, and how this would preserve his/her legal
rights:
8c. Specify the facts regarding your suitability, ability and commitment as the petitioner(s) to assume full
legal responsibility and raise him/her to adulthood:
Page 4 of 12
9. Upon information and belief, has there been any person previously appointed guardian of the subject
of this petition, pursuant to will or deed, or guardian of the person pursuant to Social Services Law §
384 or § 384-b?
G Yes G No
If yes, specify name of guardian:
10. Petitioner (1) - Name:
Upon information and belief, [check U all applicable boxes]:
10a. Petitioner (1)
G I have never been named in an indicated report, as such term is defined in the Social Services
Law §412, that has been filed with the Statewide Central Register of Child Abuse and
Maltreatment pursuant Social Services Law §422.
G I was named in an indicated report, as defined in the Social Services Law §412, that was filed with
the Statewide Central Register of Child Abuse and Maltreatment pursuant to Social Services Law
§422.
Date of the report:
What is the status and what were the circumstances of the report to the extent known?
Was the subject of this petition the subject of the report?
G Yes G No
G I am currently named in a report, as defined in the Social Services Law §412, filed with the
Statewide Central Register of Child Abuse and Maltreatment pursuant to Social Services Law
§422, that remains under investigation.
Date of the report:
What is the status and what were the circumstances of the report to the extent known?
Was the subject of this petition the subject of the report?
G Yes G No
Page 5 of 12
10b. Petitioner (1)
G I have never been named in, or was a respondent in, a child protective proceeding pursuant to
Article 10 of the Family Court Act.
G I have been named in, or was a respondent in, a child protective proceeding pursuant to Article
10 of the Family Court Act.
Did the proceeding result in an order finding that a child was/children were abused or neglected?
G Yes G No
Date of the proceeding:
What is the status and what were the circumstances of the proceeding to the extent known?
Was the subject of this petition the subject of the proceeding?
G Yes G No
10c. Petitioner (1)
G I have never been named in an Order of Protection or Temporary Order of Protection in any
Criminal, Matrimonial or Family Court proceeding(s).
G I have been named in an Order of Protection or Temporary Order of Protection in a Criminal,
Matrimonial or Family Court proceeding(s) as follows:
The court name:
Docket/Index #:
Were you protected or restrained by the order?
G Protected G Restrained
Date of order:
Expiration date of order:
Next court date:
What is the status and what were the circumstances of the order to the extent known?
Page 6 of 12
Was the subject of this petition the subject of the order?
G Yes G No
If more than one order, fill out the above with the most recent order. For additional orders,
all requested information should be provided on a separate page and attached.
10. Petitioner (2) - Name:
Upon information and belief, [check U all applicable boxes]:
10a. Petitioner (2)
G I have never been named in an indicated report, as such term is defined in the Social Services
Law §412, that has been filed with the Statewide Central Register of Child Abuse and
Maltreatment pursuant Social Services Law §422.
G I was named in an indicated report, as defined in the Social Services Law §412, that was filed with
the Statewide Central Register of Child Abuse and Maltreatment pursuant to Social Services Law
§422.
Date of the report:
What is the status and what were the circumstances of the report to the extent known?
Was the subject of this petition the subject of the report?
G Yes G No
G I am currently named in a report, as defined in the Social Services Law §412, filed with the
Statewide Central Register of Child Abuse and Maltreatment pursuant to Social Services Law
§422, that remains under investigation.
Date of the report:
What is the status and what were the circumstances of the report to the extent known?
Was the subject of this petition the subject of the report?
G Yes G No
Page 7 of 12
10b. Petitioner (2)
G I have never been named in, or was a respondent in, a child protective proceeding pursuant to
Article 10 of the Family Court Act.
G I have been named in, or was a respondent in, a child protective proceeding pursuant to Article
10 of the Family Court Act.
Did the proceeding result in an order finding that a child was/children were abused or neglected?
G Yes G No
Date of the proceeding:
What is the status and what were the circumstances of the proceeding to the extent known?
Was the subject of this petition the subject of the proceeding?
G Yes G No
10c. Petitioner (2)
G I have never been named in an Order of Protection or Temporary Order of Protection in any
criminal, matrimonial or family court proceeding(s).
G I have been named in an Order of Protection or Temporary Order of Protection in a criminal,
matrimonial or family court proceeding(s) as follows:
The court name:
Docket/Index #:
Were you protected or restrained by the order?
G Protected G Restrained
Date of order:
Expiration date of order:
Next court date:
What is the status and what were the circumstances of the order to the extent known?
Page 8 of 12
Was the subject of this petition the subject of the order?
G Yes G No
If more than one order, fill out the above with the most recent order. For additional orders,
all requested information should be provided on a separate page and attached.
11. Are there any other adults who are 18 or older who live in your home?
G Yes G No
If no, skip this section and go to number 12.
If yes, provide the requested information for all the other adults who are 18 or older, who live in your
home:
1. Name:
Date of Birth:
Relationship to the subject:
2. Name:
Date of Birth:
Relationship to the subject:
If more than two adults, all requested information for each additional adult should be
provided on a separate page and attached.
11a. G None of the adults 18 or older living in my home have ever been the subjects of any indicated
reports, as defined in the Social Services Law §412, that were filed with the Statewide Central
Register of Child Abuse and Maltreatment pursuant to Social Services Law §422.
G The following adults 18 or older living in my home have been the subjects of indicated reports, as
defined in the Social Services Law §412, that were filed with the Statewide Register of Child
Abuse and Maltreatment pursuant to Social Services Law §422:
Name:
Date of report:
What is the status and what were the circumstances of the report to the extent known?
Page 9 of 12
Was the subject of this petition the subject of the report?
G Yes G No
If more than one report, fill out the above with the most recent report. For additional
reports, all requested information should be provided on a separate page and attached.
G The following adults 18 or older living in my home are the subjects of reports, as defined in the
Social Services Law §412, filed with the Statewide Central Register of Child Abuse and
Maltreatment pursuant to Social Services Law §422, that remain under investigation:
Name:
Date of report:
What is the status and what were the circumstances of the report to the extent known?
Was the subject of this petition the subject of the report?
G Yes G No
If more than one report, fill out the above with the most recent report. For additional
reports, all requested information should be provided on a separate page and attached.
11b. G None of the adults 18 or older living in my home have ever been named in , or were the
respondents in child protective proceedings pursuant to Article 10 of the Family Court Act.
G The following adults 18 or older living in my home have been named in, or were the respondents
in child protective proceedings pursuant to Article 10 of the Family Court Act:
Name:
Did the proceedings result in orders finding that the child is an abused or neglected
child?
G Yes G No
Date of proceedings:
What is the status and what were the circumstances of the proceeding to the extent known?
Was the subject of this petition the subject of the proceedings?
G Yes G No
If more than one case, fill out the above with the most recent case. For additional cases,
all requested information should be provided on a separate page and attached.
Page 10 of 12
11c. G None of the adults 18 or older living in my home have ever been named in Orders of Protection
or Temporary Orders of Protection in any criminal, matrimonial or family court proceeding(s).
G The following adults 18 or older living in my home have been named in Orders of Protection or
Temporary Orders of Protection in criminal, matrimonial or family court proceeding(s):
Name:
Was this adult protected or restrained by the order?
G Protected G Restrained
Docket/Index #: Date of order:
What is the status and what were the circumstances of the order to the extent known?
Was the subject of this petition the subject of the order?
G Yes G No
If more than one order, fill out the above with the most recent order. For additional orders,
all requested information should be provided on a separate page and attached.
12. The birth parents of the subject of this petition [specify names of parents]:
, although living, should not be appointed guardian
of the subject because:
13a. Is the person who is the subject of this petition over the age of 18, and has he/she consented to the
appointment of the guardian?
G Yes and a copy of the consent form is attached G No
13b. Is the person who is the subject of this petition over 14 years of age, but less than 18, and has he/she
expressed a preference for the appointment of the guardian?
G Yes and a copy of the preference form is attached G No
14. There are no persons interested in this petition other than those already listed.
Page 11 of 12
15. Has there been any application made to any court, including a Native American tribunal, for the relief
requested herein?
G Yes G No
Name of Court:
Date of application:
16. Check U one box:
G Wherefore, petitioner requests that an order be entered appointing me(us) to be the guardian(s)
of the person until the subject reaches the age of 18 and that letters of guardianship issue.
G Wherefore, petitioner requests that an order be entered appointing me(us) to be the guardian(s)
of the person until the subject reaches the age of 21 (if the subject is 18 or over) upon his/her
consent, and that letters of guardianship issue.
Dated:
Petitioner (1) [sign name]
Petitioner (1) [print name]
Petitioner (2) [sign name]
Petitioner (2) [print name]
VERIFICATION
STATE OF )
:ss.:
COUNTY OF )
being duly sworn, says that (s)he is the Petitioner in the above-named proceeding and that the foregoing petition
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.
Petitioner (1) [sign name before notary]
Sworn to before me this
day of , 20
Notary Public
Page 12 of 12
VERIFICATION
STATE OF )
:ss.:
COUNTY OF )
being duly sworn, says that (s)he is the Petitioner in the above-named proceeding and that the foregoing petition
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.
Petitioner (2) [sign name before notary]
Sworn to before me this
day of , 20
Notary Public
Download
Save PDF to desktop
Email
Email completed PDF
Send for Signing
Email for others to sign
Print
Print document
Choose a Field
Click on a field and
select the person that should complete it
Want to add a signature?
You can add a signature field
and assign it to someone else
to sign
Choose a Field
Click on a field and
select the person that should complete it

Page 1 of 12 F.C.A. 661 Form 6-1 (NYS Unified Court System Division of Technology)

This document is locked as it has been sent for signing.

You have successfully completed this document.

Other parties need to complete fields in the document. You will recieve an email notification when the document has been completed by all parties.

This document has been signed by all parties.

Completed 13 September 2021

Message

View Audit Log
Print With Audit Log
Duplicate Document