F.C.A. §§ 413, 440, 442-447, 449, 451, 461, 466, 467 Form 4-11a (Support- Order Extending, Modifying or Terminating Order of Support Made by Family Court or 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 , . 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 (Commissioner of Social Services, Assignee, on behalf of , Assignor) Docket No. Petitioner, S.S. #: xxxx-xx-againstRespondent ORDER ON PETITION TO G EXTEND G MODIFY G TERMINATE AN ORDER OF SUPPORT MADE BY G FAMILY COURT G ANOTHER COURT 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. 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 THE APPELLANT IN COURT, 30 DAYS AFTER SERVICE BY A PARTY OR THE American LegalNet, Inc. www.FormsWorkFlow.com Form 4-11a page 2 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. 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 petition having been filed in this Court seeking to Q terminate Q extend Q modify a Q judgment Qorder, dated , , granting support made by the Q Supreme Court of the State of New York, County, entitled Index No. Q Family Court of County Q Other court: ; and [Check applicable box(es)]: Q It appearing that under the terms of the Q judgment Q order the Q Supreme Court Q Other [specify]: Q has Q has not retained exclusive jurisdiction to modify the Q judgment Q order; and Q It appearing that the outside the State of New York; and Court is a court of competent jurisdiction Q It appearing that [check applicable box(es)]:: Q there has been a substantial change of circumstances since the entry of the Qjudgment Qorder; Q there has been a change in excess of 15% in income since the entry of the Qjudgment Qorder and the parties had not opted out of this ground for modification in a validly executed written agreement or stipulation;1 Q three years have elapsed since the entry of the Qjudgment Qorder and the parties had not opted out of this ground for modification in a validly executed written agreement or stipulation;2 Q no grounds exist in accordance with Family Court Act §451(2) or Domestic Relations Law §236B(9)(b)(2) for seeking a modification of child support; 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, the Court finds that; 1 This ground only applies to original or modified support orders entered on or after October 13, 2010. This ground only applies to original or modified support orders entered on or after October 13, 2010. American LegalNet, Inc. www.FormsWorkFlow.com 2 Form 4-11a page 3 The basic child support obligation for support of the following child(ren) is $____________ Q weekly, Q every two weeks, Q monthly, Q twice per month, Q quarterly: NAME DATE OF BIRTH SOC. SEC. # (last 4 digits) AMOUNT The mother is the Qcustodial Q non-custodial parent, whose pro rata share of the basic child support obligation is $_______________; The father is the Qcustodial Qnon-custodial parent, whose pro rata share of the basic child obligation is $ ___________ Q weekly, Q every two weeks, Q monthly, Q twice per month, Q quarterly; And the Court finds further that: G The non-custodial parent's pro rata share of the basic child support obligation is neither unjust nor inappropriate; 3 OR 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;4 [Applicable in cases in which the parties stipulated to an order of child support]: Q And the Court finds that the parties have voluntarily stipulated to child support for the child(ren)[names] __________________________________________ payable by ________________________ in the amount of $____________ Q weekly, Q every two weeks, Q monthly, Q twice per month, Q quarterly. Q This stipulation has been entered into the record and recites, in compliance with Family Court Act § 413(1)(h), 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 Social Services Law § 111-i; 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 3 This paragraph is to be used if the basic child support obligation is applied without deviation. This paragraph is to be used only 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 4 Form 4-11a page 4 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)]: ; The name, address and telephone number of Q Respondent's Q (modification