F.C.A. § 413, Art.5-B Form 4-19a (Order Determining Objections to Proposed Adjustment) 8/2010 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 4 of the Family Court Act (Commissioner of Social Services, Assignee, on behalf of , Assignor ) Petitioner (Assignor) Docket No. ORDER (Determination of Objections to Proposed Adjustment) S.S.#: xxxx-xx- -againstRespondent. S.S.#: xxxx-xx_______________________________________ NOTICE: YOUR WILLFUL FAILURE TO OBEY THIS ORDER MAY RESULT IN INCARCERATION FOR CRIMINAL NON-SUPPORT OR CONTEMPT. YOUR FAILURE TO OBEY THIS ORDER MAY RESULT IN SUSPENSION OF YOUR DRIVER'S LICENSE, STATE-ISSUED PROFESSIONAL, TRADE, BUSINESS AND OCCUPATIONAL LICENSES 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 AFTER RECEIPT BY APPELLANT OF THE ORDER IN COURT, 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 THE COURT, WHICHEVER IS EARLIEST. American LegalNet, Inc. www.FormsWorkFlow.com Form 4-19a page 2 IF THIS ORDER WAS ENTERED BY A HEARING EXAMINER, 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 PERSONAL SERVICE, OR IF THE ORDER WAS RECEIVED BY MAIL, WITHIN 35 DAYS OF THE MAILING OF THE ORDER. A proposed adjusted order in the above-entitled proceeding dated , having been timely submitted to the Court and timely objections to the proposed adjusted order having been filed with the Court, (and timely rebuttal having been filed by the Support Collection Unit with this Court), and this Court having reviewed the objections (and timely rebuttal) filed herein, (and a hearing having been held), NOW, therefore, it is hereby [Delete inapplicable provisions]: (ORDERED that the objections are denied and the proposed adjusted order shall be executed immediately) (ORDERED that the objections are sustained and the existing order is continued, as no basis is found at present for adjustment of the order.) (ORDERED that the objections are sustained and a new order of child support is issued. ) [See attached order]. (ORDERED that the objections are sustained and the matter is remanded to the Support Collection Unit for the following action): );and it is further (ORDERED ). ENTER Dated: , . _____________________________________ Judge of the Family Court/Support Magistrate Check applicable box: 9 Order mailed on [specify date(s) and to whom mailed ]:___________________________ 9 Order received in court on [specify date(s) and to whom given]:_____________________ American LegalNet, Inc. www.FormsWorkFlow.com