F.C.A. §§ 413, 416, 433, 438, 439, 440,442-447, 449, 471;Art.5-B Form 4-7 (Order of Support) 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 of the Family Court Act (Commissioner of Social Services , Assignee, on behalf of , Assignor) S.S.#: xxxx-xxPetitioner, -againstRespondent. S.S.#: 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. NOTICE: IF YOU WERE NOT IN COURT FOR THE HEARING AND THIS ORDER WAS ISSUED ON DEFAULT, YOU MAY OBJECT OR CHALLENGE THE ORDER BY FILING A MOTION TO VACATE THE ORDER. IF YOU WERE IN COURT FOR THE HEARING AND THIS ORDER IS ENTERED BY A JUDGE, PURSUANT TO SECTION 1113 OF THE FAMILY COURT ACT, AN APPEAL FROM THIS ORDER MUST BE TAKEN WITHIN 30 DAYS OF 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 ORDER TO APPELLANT BY THE CLERK OF COURT, WHICHEVER IS EARLIEST. IF YOU WERE IN COURT FOR THE HEARING AND 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 PERSONAL SERVICE, OR IF THE ORDER WAS RECEIVED BY MAIL, WITHIN 35 DAYS OF THE MAILING OF THE ORDER. American LegalNet, Inc. www.FormsWorkFlow.com Docket No. ORDER OF SUPPORT Check applicable box: G Respondent Present G By Default Form 4-7 Page 2 The above-named Petitioner having filed a petition, dated , above-named Respondent is chargeable with the support of [specify child(ren)]: (and) ; , alleging that the and [Check applicable box]: G Respondent having appeared before this Court to answer the petition and to show why an order of Support and other relief requested in the petition should not be granted; and Respondent, after having been advised of the right to counsel, having Q denied Q admitted the allegations of the petition; OR G Respondent having failed to appear before this Court or to answer the petition after having been properly served; and The matter having duly come on to be heard before this Court; 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: NAME The basic child support obligation for support of the following child(ren) is $_______ DATE OF BIRTH SOCIAL SECURITY # (LAST 4 DIGITS) The mother is the G custodial G non-custodial parent, whose pro rata share of the basic child support obligation is __________________________; The father is the G custodial G non-custodial parent, whose pro rata share of the basic child obligation is _______________________; And the Court finds further that [check applicable box]: G The non-custodial parent's pro rata share of the basic child support obligation is neither unjust nor inappropriate; G Upon consideration of the following factors specified in Family Court Act §413(1)(f): the non-custodial parent's pro rata share of the basic child support obligation is G unjust G inappropriate for the following reasons [specify]: 1 [Applicable in cases in which the parties stipulated to an order of child support]: G And the Court finds further that the parties have voluntarily stipulated to child support for the following child(ren)[specify]: payable by [specify]: to [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 the record and recites, in compliance with Section 413(1)(h) of the Family Court Act, that: This paragraph is to be used only if the court's order deviates from the basic child support obligation, pursuant to F.C.A. Section 413(1)(g). Delete if inapplicable. American LegalNet, Inc. www.FormsWorkFlow.com 1 Form 4-7 Page 3 a. The parties have been advised of the provisions of Section 413(1)of the Family Court Act; 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: [See Family Court Act§ 413(1)(f)]: The name, address and telephone number of Respondent's current employer(s), are: NAME ADDRESS TELEPHONE NOW, after examination and inquiry into the facts and circumstances of the case (and after hearing the proofs and testimony offered in relation thereto), it is ORDERED AND ADJUDGED that the above-named Respondent is chargeable with the support of the following person(s) and is possessed of sufficient means and able to earn such means to provide the payment of the sum $ G weekly G every two weeks G monthly Gtwice per month G quarterly, such payments to commence on , , allocated as follows for and toward the support of Respondent's spouse and children as follows: Name spouse, if any: child(ren): Total: ORDERED that, pursuant to Domestic Relations Law §236(B)(1)(a), payments for the support of Respondent's spouse shall terminate upon the death of the spouse, upon the spouse's valid or invalid marriage or upon modification in accordance with Domestic Relations Law §236(B)(9) or 248; and it is further Date of Birth Amount Per Time Period