F.C.A. §§ 458-a,458-b, 458-c 548-a, 548-b, Art. 5-b Form 4-21 (Order to Licensing Entity) (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 _______________________________ . PRESENT: HON:_______________________________ Judge/Support Magistrate ....................................... In the Matter of a Proceeding for Support under Article _______ of the Family Court Act Petitioner, S.S.#: xxxx-xx-againstRespondent. S.S.#: xxxx-xxRespondent's Address:1 DOB Docket No.______________ ORDER TO LICENSING ENTITY ...... ................................. TO: G (NEW YORK STATE DEPARTMENT OF MOTOR VEHICLES) G (OTHER NEW YORK STATE PROFESSIONAL, OCCUPATIONAL, BUSINESS OR RECREATIONAL , LICENSING ENTITY) [SPECIFY]: ____________________________ An Order of Support under Article ______ of the Family Court Act having been made by this court on ______________________; [Check applicable box(es)]: G And this Court having determined, in an order, dated ______________________,____________, that the Respondent therein has accumulated unpaid child support or combined child and spousal support arrears equivalent to or in excess of the amount of current support due for a period of four months,) G And this Court having determined that the Respondent, after having received appropriate notice, failed to comply with a G summons G subpoena G warrant relating to a G paternity G child support proceeding,) Now, therefore, it is hereby ORDERED that the G New York State Department of Motor Vehicles G Other state professional, business, occupational or recreational, licensing entity [specify]:____________________________________________ commence proceedings to suspend Respondent's G motor vehicle operator's license G professional, business, Unless the Court has ordered the address to be confidential on the ground that disclosure would pose an unreasonable health or safety risk. See Family Court Act §154-b; General Form 21 (available at www.nycourts.gov). 1 American LegalNet, Inc. www.FormsWorkFlow.com Form 4-21 Page 2 occupational or recreational licenses or permit [specify]:_________________________________________________; and it is further ORDERED that the G New York State Department of Motor Vehicles G above-named professional, business, occupational or recreational licensing entity report back to the Court regarding the outcome of the proceedings and all actions taken pursuant thereto by [specify date]: ___________________________________________________________ and it is [Applicable to professional, occupational and business licenses only] G ORDERED that the execution of this Order be suspended for a period [specify period not to exceed one year from the date of this order]: Dated:________________________,___________. ENTER _____________________________________ Judge of the Family Court/Support Magistrate 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 THE APPELLANT BY THE CLERK OF 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. Check applicable box regarding Petitioner/Respondent: G Order mailed on [specify date(s) and to whom mailed]:____________________________________ G Order received in court on [specify date(s) and to whom given]:___________________________ Order Mailed To:___________________________________________________________________________ Name of Licensing Entity Notice to New York State Department of Motor Vehicles: Section 510(4-e) (3) of the Vehicle and Traffic Law provides that upon receiving this order the Commissioner or his or her agent shall suspend the license of the Respondent to operate a motor vehicle or, if Respondent is unlicensed, the Respondent's privilege of obtaining a license. The suspension shall take effect no later that 15 days from the date of the order and shall remain in effect until such time as the Commissioner is advised that Respondent has satisfied the support arrears or has made satisfactory payment arrangements pursuant to Social Services Law § 111-b(12)(e) or until such time as the Court issues an order to terminate such suspension. Notice to state professional or business licensing entities: Education Law § 6509-b, Real Property Law § 441-c, Alcoholic Beverages Control Law § 119(4) and Judiciary Law § 90(2-1) provide that, upon receipt of an order from the Family Court, pursuant to Section 458-b of the Family Court Act, the licensing entity shall provide notice to the licensee or permittee within 30 days of receipt of the order that a hearing will be held to suspend the license or permit. Unless the court order specifies that the license suspension direction is not to be executed for a period not to exceed one year, the hearing must be held at least 20 and no more than 30 days after the sending of such notice. The hearing is limited solely to a determination whether full payment of the arrearage has been made as of the date of the hearing. The licensee or permittee shall be given an opportunity in person or by counsel to present proof of full payment, which shall include a certified check showing full payment or a notice issued by the Court or Support Collection Unit indicating such payment. No evidence regarding the appropriateness of the court order or the ability of the licensee or permittee to comply with the order shall be received or considered by the licensing entity. A suspension order shall not be lifted unless the Court or Support Collection Unit issues a notice to the licensing entity that full payment of the arrearage has been made. The licensing entity is required to report to the Family Court as to the outcome of the proceedings and all actions taken pursuant thereto. American LegalNet, Inc. www.FormsWorkFlow.com