DRL §§76-h(5); 254, FCA § 154-(b); 818; 1015 FAMILY COURT OF THE STATE OF NEW YORK COUNTY OF_______________________________ ............................................................................... Petitioner -against- General Form 21a Address Confidentiality Order 8/2010 ADDRESS CONFIDENTIALITY ORDER DOCKET NO. ___________ Respondent .............................................................................. An affidavit having been filed in this Court requesting that a party or child(ren)'s address(es) and/or other identifying information not be disclosed, NOW, it is hereby ORDERED, that the present and all future address(es) and/or other identifying information of [specify name]: ______________________ and child(ren)[specify name(s)]: _____________________ _____________not be disclosed in any pleading, document, or proceeding in this Court; and it is further ORDERED, that the following person is designated as the agent for service of process and papers in this case [specify name and address]: Q Clerk of Court _________________________________________________________ Q Attorney ______________________________________________________________ Q Other _________________________________________________________________ ORDERED, that [specify name of protected party]: ____________________ must inform the above- named agent for service of process and papers of all changes of address. 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, 35 DAYS FROM THE DATE OF MAILING OF THE ORDER TO APPELLANT BY THE CLERK OF COURT, OR 30 DAYS AFTER SERVICE BY A PARTY OR THE ATTORNEY FOR THE CHILD UPON THE APPELLANT, WHICHEVER IS EARLIEST. Dated: , . ENTER ________________________________________ (Judge of the Family Court)(Support magistrate) Check applicable box: 9 Order mailed on [specify date(s) and to whom mailed ]:___________________________ 9 Order received in court on [specify date(s) and to whom given]:_____________________ American LegalNet, Inc. www.FormsWorkFlow.com Form GF-21a Page 2 IF 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 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 PROFESSIONAL SERVICE, OR IF THE ORDER WAS RECEIVED BY MAIL, WITHIN 35 DAYS OF THE MAILING OF THE ORDER. American LegalNet, Inc. www.FormsWorkFlow.com