COURT COUNTY .OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ........ .. PETITIONER ./ PLAINTIFF: :
RESPONDENT / DEFENDANT:
Index No. Calendar No.
Attachment to Child Custody and Visitation Order:Attachment (form FL-341) JUDICIAL SUBPOENA Plaintiff(s)
SUPERVISED VISITATION ORDER
-against1. Evidence has been presented in support of a request that the contact of be supervised based upon allegations of abduction of child(ren) physical abuse drug abuse sexual abuse domestic violence alcohol abuse
Respondent Petitioner investigation and hearing or trial.
: Petitioner : :
with the child(ren)
neglect other (specify):
Defendant(s) : ......................................................
disputes these allegations and the court reserves the findings on these issues pending further
2. The court finds, under Family Code section 3100, that the best interest of the child(ren) requires that visitation by Respondent must, until further order of the court, be limited to contact supervised by the person(s) set Petitioner forth in item 6 below pending further investigation and hearing or trial.
THE PEOPLE OF THE STATE OF NEW YORK
THE COURT MAKES THE FOLLOWING ORDERS TO 3. CHILD(REN) TO BE SUPERVISED Birth date Child's name
GREETINGS: WE COMMAND YOU, that all business and excuses being laid aside, you and each of you attend before , at the Court c. b. Supervised exchange only Therapeutic visitation located at in room , on the day of , 20 , at o'clock in the noon, and at any recessed 5. SUPERVISED VISITATION PROVIDER or adjourned date, to testify and give evidence as a witness in this action on the part of the
4. TYPE Honorable the a. County of Supervised visitation a. Professional (individual provider or supervised visitation center) b. Nonprofessional 6. AUTHORIZED PROVIDER Name
Address Your failure to comply with this subpoena is punishable as a contempt of court and Telephone you liable to will make the party on whose behalf this subpoena was issued for a maximum penalty of $50 and all damages sustained as a result of your failure to comply. Any other mutually agreed-upon third party as arranged.
7. DURATION AND FREQUENCY OF VISITS day of (see form FL-341 for ,specifics of visitation): Court in County, 20
, one of the Justices of the
8. PAYMENT RESPONSIBILITY 9.
Respondent: ______% (Attorney must sign above and type name below)
Petitioner will contact professional provider or supervised visitation center no later than (date): Respondent will contact professional provider or supervised visitation center no later than (date):
10. THE COURT FURTHER ORDERS
Office and P.O. Address
Form Adopted for Mandatory Use Judicial Council of California FL-341(A) [Rev. January 1, 2003]
Telephone No.: Facsimile No.: E-Mail Address: Mobile Tel. SUPERVISED VISITATION ORDER No.:
JUDICIAL OFFICER Page 1 of 1 Family Code, §§ 3100, 3031 www.courtinfo.ca.gov
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