F.C.A. § 454(5); Art 5-B Form 4-22 (Objection to Support Collection to Unit Denial of Challenge to Driver's License Suspension) 5/2015 FAMILY COURT OF THE STATE OF NEW YORK COUNTY OF ______________________________________ (Commissioner of Social Services, Assignee. on behalf of , Assignor) PETITIONER1 -AGAINSTRespondent ________________________________________ NOTICE: IF YOU OBJECT TO THE DETERMINATION OF THE SUPPORT COLLECTION UNIT DENYING YOUR CHALLENGE TO THE SUSPENSION OF YOUR DRIVING PRIVILEGES, THIS FORM MUST BE FILED WITH THE CLERK OF THE FAMILY COURT WITHIN 35 DAYS OF THE DATE OF MAILING OF THE NOTICE FROM THE SUPPORT COLLECTION UNIT DENYING YOUR CHALLENGE. THIS FORM MUST BE ACCOMPANIED BY PROOF THAT IT HAS BEEN SERVED UPON THE SUPPORT COLLECTION UNIT AND SENT TO THE OPPOSING PARTY AT HIS/HER LAST KNOWN ADDRESS BY FIRST CLASS MAIL.SUCH PROOF MAY INCLUDE THE AFFIDAVIT OF SERVICE AT THE END OF THIS FORM. THE SUPPORT COLLECTION UNIT HAS TEN DAYS FROM SUCH SERVICE IN WHICH TO FILE A WRITTEN REBUTTAL. Docket No. OBJECTION TO SUPPORT COLLECTION UNIT DENIAL OF CHALLENGE TO DRIVER'S LICENSE SUSPENSION I am a party in the above-entitled proceeding and object to the denial by the Support Collection Unit of my challenge , dated [specify]: , , to the Support Collection Unit's determination to notify the Department of Motor Vehicles to suspend my driving privileges. The grounds for my objections are as follows: 1 Use caption of original petition. American LegalNet, Inc. www.FormsWorkFlow.com Form 4-22 Page 2 Date: , . ________________________________ Petitioner ________________________________ Print or type name ________________________________ Signature of Attorney, if any ________________________________ Attorney's Name (Print or Type) ________________________________ ________________________________ ________________________________ Attorney's Address and Telephone Number THIS SECTION IS REQUIRED IN ALL CASES: AFFIDAVIT OF SERVICE ___________________________________________ Petitioner against Docket No. _____________ ____________________________________________ Respondent STATE OF NEW YORK ) : ss.: COUNTY OF ) I, _________________________, being duly sworn, depose and say: I have served this Objection upon the [check applicable box]: QSupport Collection Unit Q NYC HRA Office of Legal Affairs2 at [specify]: and upon [specify name of opposing party or parties]: Qby mail Qin person [note: service in person must be made by non-party to the case] on [specify date]: ___________________________________ Sworn to before me this day of _______________________________ (Notary Public) (Deputy) Clerk _______________________________ Signature of Person Serving Objection In New York City, service of this objection may be made upon the New York City Human Resources Administration Office of Legal Affairs, Child Support Litigation Unit, 150 Greenwich Street, 38th Floor, New York, NY 10007, which represents the Support Collection Unit in these matters. American LegalNet, Inc. www.FormsWorkFlow.com 2