F.C.A.§§413, 424-a, 426, 427, 433, Art.5-B (TO BE USED FOR SERVICE WITHIN NEW YORK STATE) FAMILY COURT OF THE STATE OF NEW YORK COUNTY OF ....................................................................................... In the Matter of a Proceeding Under Article of the Family Court Act (Commissioner of Social Services, Assignee on behalf of , Assignor Form 4-la (Summons-Support) 8/2010 Docket No. Petitioner -againstRespondent SUMMONS -- SUPPORT .......................................................................................... NOTICE:YOUR FAILURE TO APPEAR MAY RESULT IN SUSPENSION OF YOUR DRIVING PRIVILEGES; STATE-ISSUED PROFESSIONAL, OCCUPATIONAL AND BUSINESS LICENSES; AND RECREATIONAL AND SPORTING LICENSES AND PERMITS.1 FURTHER, YOUR FAILURE TO APPEAR WILL RESULT IN THE ENTRY OF AN ORDER ON DEFAULT UNLESS SERVICE HAS BEEN MADE BY MAIL ALONE, IN WHICH EVENT NO DEFAULT MAY BE ENTERED WITHOUT PROOF SATISFACTORY TO THE COURT THAT YOU HAVE RECEIVED ACTUAL NOTICE OF THE COMMENCEMENT OF THIS PROCEEDING. YOU ARE FURTHER ADVISED THAT, UPON YOUR APPEARANCE ON THE RETURN DATE OF THIS SUMMONS, YOU MUST PROVIDE PROOF OF YOUR INCOME AND ASSETS AND A TEMPORARY OR PERMANENT ORDER OF SUPPORT WILL BE ISSUED. YOU HAVE A RIGHT TO BRING A LAWYER WITH YOU, IF YOU CHOOSE. 1 Pursuant to Section 433 of the Family Court Act, you may qualify to testify by telephone, audio-visual means or other electronic means if you reside in a county in New York State not contiguous to the Family Court in which the matter will be heard, if you are incarcerated and do not expect to be released within a reasonable period of time after the scheduled date or if you will suffer an undue hardship by appearing in court. The five counties of New York City are treated as one county for purposes of this section. If you wish to request permission, you must submit Form 4-24/5-16/UIFSA-10, which you may obtain from Family Court or on the internet at www.nycourts.gov. American LegalNet, Inc. www.FormsWorkFlow.com Form 4-1a Page 2 BY ORDER OF THE FAMILY COURT OF THE STATE OF NEW YORK TO THE ABOVE-NAMED RESPONDENT: _______________________________, who resides or is found at: . A petition under Article Court, and annexed hereto, of the Family Court Act having been filed with this YOU ARE HEREBY SUMMONED to appear before the Family Court at ___________________________________________, New York, on , at o'clock in Q morning Qafternoon of that day to answer the petition and to be dealt with in accordance with Article __ of the Family Court Act. On your failure to appear as herein directed, a warrant may be issued for your arrest. You must provide the court with proof of your income and assets by _________________ , , on the attached form provided for that purpose. You are required to attach a current and representative paycheck stub and most recently filed state and federal income tax returns to said form, including a copy of the W-2 wage and tax statement(s) submitted with the returns. You may be required to furnish past and present income tax returns; employer statements; pay stubs; corporate, business or partnership books and records; corporate and business tax returns; and receipts for expenses or such other measures of verification as the Court determines appropriate. Dated: , . _______________________________ Clerk of the Court NOTICE: Family Court Act §154(c) provides that support, paternity, custody, family offense and child abuse and neglect petitions, in which an order of protection is sought or in which a violation of an order of protection is alleged, may be served outside the State of New York upon a Respondent who is not a resident or domiciliary of the State of New York. In such instance, the exercise of personal jurisdiction over the Respondent is limited to the issue of the request for, or alleged violation of, the order of protection, unless other grounds exist for the exercise of personal jurisdiction over the Respondent. Where the Respondent has been served with this summons and petition and does not appear, the Family Court may proceed to a hearing with respect to issuance or enforcement of the order of protection. American LegalNet, Inc. www.FormsWorkFlow.com