F.C.A. §§ 438, 440, 460, 461,466, 467, D.R.L. § 244 Form 4-13a (Support- Order on Petition for Enforcement of an Order Made By Another Court) 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 , . PRESENT: Hon. Judge/Support Magistrate ............................................................................ In the Matter of a Proceeding for Support Under Article 4 of the Family Court Act Docket No. ORDER ON PETITION FOR ENFORCEMENT OF AN ORDER OF SUPPORT MADE BY ANOTHER COURT (Commissioner of Social Services, Assignee, on behalf of , Assignor) Petitioner. S.S.#: xxxx-xx- againstRespondent. SS.#: xxxx-xx........................................................................... NOTICE: YOUR WILLFUL FAILURE TO OBEY THIS 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 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 OF THE ORDER BY APPELLANT 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 American LegalNet, Inc. www.FormsWorkFlow.com Form 4-13a page 2 ORDER TO APPELLANT BY THE CLERK OF THE COURT, WHICHEVER IS EARLIEST. IF THIS ORDER WAS 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 PERSONAL SERVICE, OR IF THE ORDER WAS RECEIVED BY MAIL, WITHIN 35 DAYS OF THE MAILING OF THE ORDER. The above-named Petitioner having filed a petition in this Court for the enforcement of a Qjudgment Qorder granting support dated , , made by the QSupreme Court of the State of New York, County Q Other court [specify]: entitled Index No. ; and The name, date of birth and social security number (lst four digits) of the child(ren) are: NAME DATE OF BIRTH LAST 4 DIGITS OF SOC. SEC. # The matter having duly come on to be heard before this court, and it appearing that under the terms of the Qjudgment Qorder, the QSupreme Court Q Other court [specify]: has not retained exclusive jurisdiction to enforce the Qjudgment Qorder; Q And it appearing that the the State of New York [check box if applicable], Court is a court of competent jurisdiction outside NOW, after examination and inquiry into the facts and circumstances of the case, and after hearing the proofs and testimony offered in relation thereto, [Applicable to cases of spousal support or maintenance only]: Q And the Respondent having Qshown Qfailed to show good cause for failure to make application for relief from the Qjudgment Qorder directing payment prior to the accrual of the arrears; [Check applicable box]: Q IT IS ADJUDGED that the petition has not been sustained and is dismissed; OR Q IT IS ADJUDGED that the Respondent failed to comply with the Qjudgment Qorder, and that such failure Q was Q was not willful; and it is further Q ADJUDGED that the Respondent knowingly, consciously and voluntarily disregarded Q his Q her obligation under a lawful court order in that Respondent willfully failed to pay the sum of $ which amount the Court finds to be the arrears due and owing under the order; The name, address and telephone number of Respondent's current employer(s) are: NAME ADDRESS TELEPHONE American LegalNet, Inc. www.FormsWorkFlow.com Form 4-13a page 3 Q ORDERED that the Qjudgment Qorder of support dated is further , is hereby continued; and it [Applicable to IV-D cases only]: G ORDERED that the Respondent pay the additional sum of $ G weekly G every two weeks G monthly Gtwice per month G quarterly. towards arrears of $ ; and with respect to such arrears payments, the Court finds that any anticipated tax refunds have been considered by the Court and taken into account in determining the amount of periodic payments to be paid toward said arrears and further directs that such arrears are not to be certified to the State Tax Commission pursuant to section 171-c of the Tax Law; and it is further G ORDERED that judgment be entered in favor of the Petitioner against the Respondent in the amount of $ , G plus interest [CPLR 5004] from , , in the amount of $ , G plus costs and disbursements in the amount of $ , for a total sum of $ ; and it is further [SUPPORT MAGISTRATE ORDER ONLY] G RECOMMENDED that the Respondent be committed to county jail, subject to confirmation by a Judge of this Court; and it is further [IV-D public assistance cases only]: work activities [specify program]: G ORDERED that the Respondent participate in the following ; and it is further G ORDERED that the Respondent shall provide an undertaking for support pursuant to Section 471 of the Family Court Act; and it is further G ORDERED that an order of sequestration shall be entered pursuant to Section 457 of the Family Court Act; and it is further GORDERED that Respondent pay counsel fees in the amount of $ to G , attorney for the Petitioner G , attorney for , a person acting on behalf of the child(ren); and it is further G ORDERED 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 Processing Center, P. O. Box 15365, Albany, NY 12212-5365. The county name for the matter must be included with the payment for identification purposes. G IV-D cases: Payable by check or money order made payable to and mailed to the NYS Child Support Processing Center, PO Box 15363, Albany, NY 12212-5363. The county name and New York Case Identifier number for the matter must be included with the payment for identification purposes; and it is further American LegalNet, Inc. www.FormsWorkFlow.com Form 4-13a page 4 [Non-IV-D cases only]: Q ORDERED that, pursuant to Family Court Act §440(1)(b)(2), this order shall be enforceable by immediate income deduction order issued in accordance with Se