F.C.A. § 413 Form 4-19b (Order Determining Objections to Adjusted Order-COLA) 5/2015 At a term of the Family Court of the State of New York, held in and for the County of , at , New York on , . P R E S E N T: Hon : Judge/Support Magistrate -------------------------------------------------------------In the Matter of a Proceeding for Support Under Article _____ of the Family Court Act (Commissioner of Social Services, Assignee, on behalf of , Assignor) Petitioner S.S.#: xxxx-xx- againstRespondent. S.S. # xxxx-xx--------------------------------------------------------------NOTICE: IF A NEW SUPPORT ORDER IS ISSUED, YOUR WILLFUL FAILURE TO OBEY THAT ORDER MAY RESULT IN COMMITMENT TO JAIL FOR A TERM NOT TO EXCEED SIX MONTHS FOR CONTEMPT OF COURT OR PROSECUTION FOR CRIMINAL NON-SUPPORT. YOUR FAILURE TO OBEY THAT ORDER MAY RESULT IN SUSPENSION OF YOUR DRIVER'S LICENSE, STATE- ISSUED PROFESSIONAL, TRADE, BUSINESS, OCCUPATIONAL AND RECREATIONAL AND SPORTING LICENSES AND PERMITS; AND IMPOSITION OF REAL OR PERSONAL PROPERTY LIENS. IF THIS ORDER WAS ENTERED BY A JUDGE, THE ORDER MAY BE APPEALED PURSUANT TO SECTION 1113 OF THE FAMILY COURT ACT. THAT SECTION PROVIDES THAT AN APPEAL FROM THAT ORDER MUST BE TAKEN WITHIN 30 DAYS OF RECEIPT OF THE ORDER BY THE APPELLANT IN COURT, OR 30 DAYS AFTER SERVICE BY A PARTY OR THE ATTORNEY FOR THE CHILD UPON THE APPELLANT, OR 35 DAYS FROM THE DATE OF MAILING OF THE ORDER TO APPELLANT BY THE CLERK OF COURT, WHICHEVER IS EARLIEST. IF THIS ORDER IS ENTERED BY A SUPPORT MAGISTRATE, SPECIFIC WRITTEN OBJECTIONS TO THIS ORDER MAY BE FILED WITH THIS COURT WITHIN 30 DAYS OF THE DATE THE ORDER WAS RECEIVED IN COURT OR BY American LegalNet, Inc. www.FormsWorkFlow.com Docket No.____________ ORDER (Determination of Objections to Adjusted Order-COLA) Form 4-19b Page 2 PERSONAL SERVICE, OR IF THE ORDER WAS RECEIVED BY MAIL, WITHIN 35 DAYS OF THE MAILING OF THE ORDER. An adjusted order dated _______________, based upon a cost of living adjustment having been timely submitted to the Court and timely objections to the proposed adjusted order having been filed with the Court, and this Court having held a hearing on those objections, NOW, after examination and inquiry into the facts and circumstances of the case (and after hearing the proofs and testimony offered in relation thereto), the Court finds that: 1. G The basic child support obligation in this case is $__________ G weekly G every two weeks G monthly Gtwice per month G quarterly for support of the following child(ren): NAME DATE OF BIRTH LAST 4 DIGITS OF SOC. SEC. # 2. The mother is the Gcustodial Gnon-custodial parent, whose pro rata share of the basic child support obligation is $__________ G weekly G every two weeks G monthly Gtwice per month G quarterly. 3. The father is the Gcustodial Gnon-custodial parent, whose pro rata share of the basic child support obligation is $__________ G weekly G every two weeks G monthly Gtwice per month G quarterly. 4. And the Court finds further that [check applicable box]: a. G The non-custodial parent's pro rata share of the basic child support obligation is neither unjust nor inappropriate; 1 OR G Upon consideration of the following factors specified in Family Court Act § 413(1)(f)[specify factors]: , the non-custodial parent's pro rata share of the basic child support obligation is G unjust G inappropriate for the following reasons [specify]:2 b. G The parties have voluntarily stipulated to child support for the child(ren) [names]: payable by [specify]:___________________________ in the amount of $__________ G weekly G every two weeks G monthly Gtwice per month G quarterly. G This stipulation has been entered into on the record and recites, in compliance with This paragraph is to be used if the basic child support obligation is applied without deviation. This paragraph is to be used if the court's order deviates from the basic child support obligation, pursuant to F.C.A. § 413(1)(g). American LegalNet, Inc. www.FormsWorkFlow.com 1 2 Form 4-19b Page 3 Section 413(1)(h) of the Family Court Act, that: a. The parties have been advised of the provisions of Family Court Act §413(1); b. The unrepresented party, if any, has received a copy of the child support standards chart promulgated by the Commissioner of the N.Y.S. Office of Temporary and Disability Assistance pursuant to Section 111-i of the Social Services Law; c. The basic child support obligation as defined in Family Court Act Section 413(1) presumptively results in the correct amount of child support to be awarded; d. The basic child support obligation in this case is $__________ G weekly G every two weeks G monthly Gtwice per month G quarterly; and e. The parties' reason(s) for agreeing to child support in an amount different from the basic child support obligation (is) (are) [specify]: ; G The Court approves the parties' agreement to deviate from the basic child support obligation for the following reasons: [specify; see Family Court Act Section 413(1)(f)]: 5. The name(s), address(es) and telephone number(s) of Respondent's current employer(s) (is)(are): NAME ADDRESS TELEPHONE NUMBER NOW, therefore, it is [check applicable box(es)]: G ORDERED that after application of the child support standards as set forth in §413 of the Family Court Act it has been determined that no adjustment to the order, dated is appropriate and, therefore, no order of adjustment is entered. OR G ORDERED that after application of the child support standards as set forth in section §413 of the Family Court Act a new order of support is entered as follows: ; and it is further G ORDERED and ADJUDGED that the above-named Respondent is responsible for the support so ordered from the date G of the determination of the objection G the cost of living adjustment would have been effective, __________________, to the date of this order, less the American LegalNet, Inc. www.FormsWorkFlow.com Form 4-19b Page 4 amount of $ ___________ already paid; and that the Respondent pay the sum of $________________as follows: $_________, immediately, and $__________ G weekly G every two weeks G monthly Gtwice per month G quarterly ; and it is further GORDERED that commencing on _________________the above-named Respondent, upon notice of this Order, pay or cause the above amount(s) to be paid to [check applicable box]: G Petitioner by cash, check or money order G Non-IV-D cases: Payable to the Petitioner by check or money order and mailed to the NYS Child Support Proces