Form 11539 "Voluntary Stipulation and Admission to Child Abuse and/or Neglect Pursuant to N.j.s.a. 9:6-8.21(C)" - New Jersey

What Is Form 11539?

This is a legal form that was released by the New Jersey Judiciary Court System - a government authority operating within New Jersey. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on August 19, 2019;
  • The latest edition provided by the New Jersey Judiciary Court System;
  • Easy to use and ready to print;
  • Available in Spanish;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a printable version of Form 11539 by clicking the link below or browse more documents and templates provided by the New Jersey Judiciary Court System.

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Download Form 11539 "Voluntary Stipulation and Admission to Child Abuse and/or Neglect Pursuant to N.j.s.a. 9:6-8.21(C)" - New Jersey

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New Jersey Judiciary
Voluntary Stipulation and Admission to Child Abuse and/or Neglect
Pursuant To N.J.S.A. 9:6-8.21(c)
Defendant’s Name:
County:
Defendant's Attorney:
Docket Number:
Judge:
Name(s) of Child(ren):
DOB:
Name of other parent:
Answer Each Question Completely
1.
Defendant’s Background Information
Address:
Date of birth:
How many years of school did you complete?
☐ Yes
☐ No
Do you need an interpreter?
If yes, language:
☐ Yes
☐ No
Do you need accommodation for a disability?
If yes, describe:
☐ Yes
☐ No
2.
a.
Is the child(ren) a member of a federally recognized American Indian tribe?
OR
☐ Yes
☐ No
b.
Is the child(ren) eligible for membership in a federally recognized
American Indian tribe and the biological child(ren) of a member of a
federally recognized American Indian tribe?
☐ Yes
☐ No
3.
Is it your intent to enter into a stipulation (an agreement) and admission of child
abuse and/or neglect?
☐ Yes
☐ No
4.
Are you entering into the stipulation and admission willingly, knowingly, and
voluntarily?
☐ Yes
☐ No
5.
Did anyone force, threaten, or pressure you into making this decision?
☐ Yes
☐ No
6.
Did anyone offer or promise you anything to convince you to make this
decision?
☐ Yes
☐ No
7.
Are you currently under the influence of drugs, alcohol or prescription
medication which could affect your ability to make a clear decision?
☐ Yes
☐ No
8.
Are you suffering from any mental or physical disability which could affect
your judgment?
Defendant's Initials:
Date:
Revised Form Promulgated by Notice to the Bar 08/19/2019, CN 11539
page 1 of 6
New Jersey Judiciary
Voluntary Stipulation and Admission to Child Abuse and/or Neglect
Pursuant To N.J.S.A. 9:6-8.21(c)
Defendant’s Name:
County:
Defendant's Attorney:
Docket Number:
Judge:
Name(s) of Child(ren):
DOB:
Name of other parent:
Answer Each Question Completely
1.
Defendant’s Background Information
Address:
Date of birth:
How many years of school did you complete?
☐ Yes
☐ No
Do you need an interpreter?
If yes, language:
☐ Yes
☐ No
Do you need accommodation for a disability?
If yes, describe:
☐ Yes
☐ No
2.
a.
Is the child(ren) a member of a federally recognized American Indian tribe?
OR
☐ Yes
☐ No
b.
Is the child(ren) eligible for membership in a federally recognized
American Indian tribe and the biological child(ren) of a member of a
federally recognized American Indian tribe?
☐ Yes
☐ No
3.
Is it your intent to enter into a stipulation (an agreement) and admission of child
abuse and/or neglect?
☐ Yes
☐ No
4.
Are you entering into the stipulation and admission willingly, knowingly, and
voluntarily?
☐ Yes
☐ No
5.
Did anyone force, threaten, or pressure you into making this decision?
☐ Yes
☐ No
6.
Did anyone offer or promise you anything to convince you to make this
decision?
☐ Yes
☐ No
7.
Are you currently under the influence of drugs, alcohol or prescription
medication which could affect your ability to make a clear decision?
☐ Yes
☐ No
8.
Are you suffering from any mental or physical disability which could affect
your judgment?
Defendant's Initials:
Date:
Revised Form Promulgated by Notice to the Bar 08/19/2019, CN 11539
page 1 of 6
☐ Yes
☐ No
9.
Do you understand that you have a right to a fact-finding hearing (also known as
a trial) in this case?
☐ Yes
☐ No
10. Do you understand that by agreeing to enter into a stipulation and admission,
you give up your right to a fact-finding hearing (also known as a trial)?
☐ Yes
☐ No
11. Do you understand that at a fact-finding hearing (also known as a trial), the
Division of Child Protection and Permanency (Division) must prove by a
preponderance of the evidence that you abused and/or neglected the child(ren)?
☐ Yes
☐ No
12. If you are giving up your right to such a trial, are you giving up your right to
trial of your own free will?
☐ Yes
☐ No
13. Do you understand that if there were a fact-finding hearing (also known as a
trial), a judge would determine what evidence would be admitted?
☐ Yes
☐ No
14. Do you understand that, through your attorney at a trial, you have the right to
challenge the evidence, cross-examine witnesses, and present evidence and
witnesses including your own testimony?
☐ Yes
☐ No
15. Do you understand that if at a trial you choose not to testify, the Division still
has the burden of proving the allegations against you?
☐ Yes
☐ No
16. Do you understand that if the child(ren) are found to have been abused and/or
neglected, the Division will be required to provide appropriate services to
protect the child(ren) and to assist you and your family?
☐ Yes
☐ No
17. Do you understand that as a result of your stipulation and admission and the
court's finding based on that stipulation and admission, the court will continue
to hear this matter, and you must comply with court orders?
☐ N/A ☐ Yes
☐ No
a.
Do you understand that, in care and supervision cases where the
child(ren) are at home, if you fail to comply with any court
orders, the Division might seek the removal of the child(ren)?
☐ N/A ☐ Yes
☐ No
b.
Do you understand that, in a case where the Division has custody
of the child(ren), the child(ren) might remain in the Division's
custody?
☐ N/A ☐ Yes
☐ No
18. In a case where the Division has custody of the child(ren), do you
understand that if you do not comply with court orders or it is not safe
to return the child(ren) home within one year from the date of
placement, the Division may seek a permanent plan such as
termination of parental rights followed by adoption, kinship legal
guardianship or custody to another parent or relative?
☐ Yes
☐ No
19. Do you understand that the Division has determined that the child abuse and/or
neglect allegations against you are: (check one)
☐ “established” (proceed to question 20a).
☐ “substantiated” (proceed to question 21a).
Defendant's Initials:
Date:
Revised Form Promulgated by Notice to the Bar 08/19/2019, CN 11539
page 2 of 6
20. Answer Question 20a through 20e only if stipulating and admitting to “established” child abuse or
neglect. Then proceed to Question 22.
☐ Yes
☐ No
a.
Do you understand that as a result of your stipulation and admission to
established child abuse and/or neglect and the court's finding based on that
stipulation and admission, your records will be retained by the Division?
☐ Yes
☐ No
b.
Do you understand that as a result of your stipulation and admission to
established child abuse and/or neglect and the court's finding based on that
stipulation and admission, your name will not be forwarded by the Division
to the child abuse registry maintained by the Department of Children and
Families (DCF)?
☐ Yes
☐ No
c.
Do you understand that the Division's records are confidential but may be
disclosed in certain circumstances upon receipt of a written request to the
Division?
☐ N/A
☐ Yes
☐ No
d.
Have you reviewed with your attorney the attachment to this
form outlining when this information may be released by the
Division?
☐ Yes
☐ No
e.
Do you understand that as a result of your stipulation and admission to
abuse and/or neglect and the court’s finding based on that stipulation and
admission, you are giving up your right through the administrative process
to challenge the retention of your record with the Division?
21. Answer Question 21a through 21d only if stipulating and admitting to “substantiated” child abuse
and/or neglect. Then proceed to Question 22.
☐ Yes
☐ No
a.
Do you understand that as a result of your stipulation and admission to
substantiated child abuse and/or neglect and the court's finding based on
that stipulation and admission, your name will be forwarded by the
Division to the child abuse registry maintained by DCF?
☐ Yes
☐ No
b.
Do you understand that on written request, the child abuse registry records
may be released to individuals identified in the statute pursuant to the
attached list of those persons who are subject to Child Abuse Registry
Information (CARI) checks?
☐ Yes
☐ No
c.
Do you understand that your name on the child abuse registry may
negatively affect your employment or future employment?
☐ Yes
☐ No
d.
Do you understand that as a result of your stipulation and admission to
abuse and/or neglect and the court’s finding based on that stipulation and
admission, your name shall remain on the child abuse registry of persons
who have abused and/or neglected a child, and that you are giving up your
right, either through the administrative process or through the proceedings
in court, to challenge the inclusion of your name on the registry?
☐ N/A ☐ Yes
☐ No
22. Have you had enough time to speak with your lawyer about this
stipulation and admission?
Defendant's Initials:
Date:
Revised Form Promulgated by Notice to the Bar 08/19/2019, CN 11539
page 3 of 6
☐ N/A ☐ Yes
☐ No
23. Has your lawyer answered all of your questions about this stipulation
and admission?
☐ N/A ☐ Yes
☐ No
24. Are you satisfied with the services of your lawyer on this stipulation
and admission?
☐ Yes
☐ No
25. Do you have any questions about this stipulation and admission?
☐ Yes
☐ No
26. Do you understand that this form will be submitted to the court to memorialize
your voluntary decision to stipulate and admit to abuse and/or neglect?
☐ Yes
☐ No
27. Do you understand that, as a result of your stipulation and admission and the
court's finding based on that stipulation and admission, the court will be making
a finding under a section of the law, N.J.S.A. 9:6-8.21(c), that relates to the facts
to which you admitted?
☐ Yes
☐ No
28. Do you understand that if the court does not accept your stipulation and
admission, that anything you say here today cannot be used against you in this
case?
☐ Yes
☐ No
29. Are you now prepared to provide the court with a factual basis for your
stipulation and admission of child abuse and/or neglect as defined by
N.J.S.A. 9:6-8.21(c)?
Date
Defendant
Date
Defense attorney
The Division upon receipt of a written request may release its records to the following as authorized by
N.J.S.A. 9:6-8.10a:
A public or private child protective agency authorized to investigate a report of child abuse or neglect;
A police or other law enforcement agency investigating a report of child abuse or neglect;
A physician who has before him a child whom he reasonably suspects may be abused or neglected or an
authorized member of the staff of a duly designated regional child abuse diagnostic and treatment center
which is involved with a particular child who is the subject of the request;
A physician, a hospital director or his designate, a police officer, or other person authorized to place a
child in protective custody when such person has before him a child whom he reasonably suspects may be
abused or neglected and requires the information in order to determine whether to place the child in
protective custody;
An agency, whether public or private, including any division or unit in the Department of Human
Services or the Department of Children and Families, authorized to care for, treat, assess, evaluate, or
supervise a child who is the subject of a child abuse report, or a parent, guardian, resource family parent,
or other person who is responsible for the child’s welfare, or both, when the information is needed in
connection with the provision of care, treatment, assessment, evaluation, or supervision to such child or
such parent, guardian, resource family parent, or other person and the provision of information is in the
best interests of the child as determined by the Division of Child Protection and Permanency;
Defendant's Initials:
Date:
Revised Form Promulgated by Notice to the Bar 08/19/2019, CN 11539
page 4 of 6
A court or the Office of Administrative Law, upon its finding that access to such records may be
necessary for determination of an issue before it, and such records may be disclosed by the court or the
Office of Administrative Law in whole or in part to the law guardian, attorney, or other appropriate
person upon a finding that such further disclosure is necessary for determination of an issue before the
court or the Office of Administrative Law;
A grand jury upon its determination that access to such records is necessary in the conduct of its official
business;
Any appropriate State legislative committee acting in the course of its official functions, provided,
however, that no names or other information identifying persons named in the report shall be made
available to the legislative committee unless it is absolutely essential to the legislative purpose;
A family day care sponsoring organization for the purpose of providing information on child abuse or
neglect allegations involving prospective or current providers or household members pursuant to
P.L.1993, c.350 (C.30:5B-25.1 et seq.) and as necessary, for use in administrative appeals related to
information obtained through a child abuse registry search;
The Victims of Crime Compensation Board, for the purpose of providing services available pursuant to
the “Criminal Injuries Compensation Act of 1971,” P.L.1971, c.317 (C.52:4B-1 et seq.) to a child victim
who is the subject of such report;
Any person appealing a department service or status action or a substantiated finding of child abuse or
neglect and his attorney or authorized lay representative upon a determination by the department or the
presiding Administrative Law Judge that such disclosure is necessary for a determination of the issue on
appeal;
Any person or entity mandated by statute to consider child abuse or neglect information when conducting
a background check or employment-related screening of an individual employed by or seeking
employment with an agency or organization providing services to children;
Any person or entity conducting a disciplinary, administrative, or judicial proceeding to determine terms
of employment or continued employment of an officer, employee, or volunteer with an agency or
organization providing services for children. The information may be disclosed in whole or in part to the
appellant or other appropriate person only upon a determination by the person or entity conducting the
proceeding that the disclosure is necessary to make a determination;
The members of a county multi-disciplinary team, established in accordance with State guidelines, for the
purpose of coordinating the activities of agencies handling alleged cases of child abuse and neglect;
A person being evaluated by the department or the court as a potential care-giver to determine whether
that person is willing and able to provide the care and support required by the child;
The legal counsel of a child, parent, or guardian, whether court-appointed or retained, when information
is needed to discuss the case with the department in order to make decisions relating to or concerning the
child;
A person who has filed a report of suspected child abuse or neglect for the purpose of providing that
person with only the disposition of the investigation;
A parent, resource family parent, or legal guardian when the information is needed in a department matter
in which that parent, resource family parent, or legal guardian is directly involved. The information may
be released only to the extent necessary for the requesting parent, resource family parent, or legal
guardian to discuss services or the basis for the department’s involvement or to develop, discuss, or
implement a case plan for the child;
A federal, State, or local government entity, to the extent necessary for such entity to carry out its
responsibilities under law to protect children from abuse and neglect;
Citizen review panels designated by the State in compliance with the federal “Child Abuse Prevention
and Treatment Act Amendments of 1996,” Pub.L.104-235;
Defendant's Initials:
Date:
Revised Form Promulgated by Notice to the Bar 08/19/2019, CN 11539
page 5 of 6