F. C. A. §§ 522, 523 S.S.L. §111-g [NOTE: Personal Information Form 4-5/5-1-d, containing social security numbers of parties and dependents, must be filed with this Petition] FAMILY COURT OF THE STATE OF NEW YORK COUNTY OF ............................................................................................ In the Matter of a Paternity Proceeding Petitioner, -against- Form 5-1 (Paternity Petition) 8/2010 Docket No. PATERNITY PETITION (Parent) Respondent ............................................................................................. TO THE FAMILY COURT: The undersigned petitioner respectfully shows that: 1. a. Petitioner resides at [specify]:1 . b. Respondent resides at [specify]: . 2 2. Petitioner had sexual intercourse with the above-named Respondent during a period of time beginning on or about the day of , , and ending on or about the day of , , and as a result thereof G Petitioner G Respondent became pregnant. 3. (a) G Petitioner G Respondent gave birth to a G male G female child out of wedlock on [specify date]. 1 Unless ordered confidential pursuant to Family Court Act § 154-b because disclosure would pose an unreasonable risk to the health or safety of the petitioner: see forms GF-21 and 21a, available at www.nycourts.gov. 2 Unless ordered confidential pursuant to Family Court Act § 154-b, because disclosure would pose an unreasonable risk to the health or safety of the respondent: see forms GF-21 and 21a, available at www.courts.gov. American LegalNet, Inc. www.FormsWorkFlow.com Form 5-1 page 2 (b) G Petitioner G Respondent is now pregnant with a child who is likely to be born out of wedlock. 4. G Petitioner GRespondent is the father of the child 5. At the time of conception of the child, the mother “ was not married. “ was married to [specify]: , whose last known address is [specify]: ). 6. [Check applicable boxes, if any]: G Petitioner G has acknowledged G acknowledges paternity of the child G in writing G by furnishing support G Respondent G has acknowledged G acknowledges paternity of the child G in writing G by furnishing support 7. The name and date of birth of the child involved are: Name Date of birth 8. No individual has been adjudicated father of this child, either in this court, or any other court, including a Native-American court; and no individual has signed an Acknowledgment of Paternity admitting paternity for this child, (except) [specify]: 9. No previous application has been made to any court or judge for the relief herein requested (except [specify]: 10. Petitioner: [check applicable box(es)]: G has made application for child support services with the local Department of Social Services). G is now requesting child support services by the filing of this Petition.3 G has continued to receive child support services after the public assistance or care case has closed. G does not wish to make application for child support services). G is the non-custodial parent of the subject child). 11. The subject child Gis G is not a Native American child subject to the Indian Child 3 Pursuant to Section 111-g of the Social Services Law, signing this petition is deemed to be an application for child support enforcement services. American LegalNet, Inc. www.FormsWorkFlow.com Form 5-1 page 3 Welfare Act of 1978 (25 U.S.C. §§ 1901-1963). 12. Pursuant to F.C.A §§ 545, upon the entry of an Order of Filiation, the Court shall, upon application of either party, enter an order of support for the subject child. WHEREFORE, Petitioner requests that this Court issue a summons or warrant requiring the Respondent to show cause why the Court should not enter a declaration of paternity, an order of support and such other and further relief as may be appropriate under the circumstances. NOTE: (1) A COURT ORDER OF SUPPORT RESULTING FROM A PROCEEDING COMMENCED BY THIS APPLICATION (PETITION) SHALL BE ADJUSTED BY THE APPLICATION OF A COST OF LIVING ADJUSTMENT AT THE DIRECTION OF THE SUPPORT COLLECTION UNIT NO EARLIER THAN TWENTY-FOUR MONTHS AFTER SUCH ORDER IS ISSUED, LAST MODIFIED OR LAST ADJUSTED, UPON THE REQUEST OF ANY PARTY TO THE ORDER OR PURSUANT TO PARAGRAPH (2) BELOW. SUCH COST OF LIVING ADJUSTMENT SHALL BE ON NOTICE TO BOTH PARTIES WHO, IF THEY OBJECT TO THE COST OF LIVING ADJUSTMENT, SHALL HAVE THE RIGHT TO BE HEARD BY THE COURT AND TO PRESENT EVIDENCE WHICH THE COURT WILL CONSIDER IN ADJUSTING THE CHILD SUPPORT ORDER IN ACCORDANCE WITH SECTION FOUR HUNDRED THIRTEEN OF THE FAMILY COURT ACT, KNOWN AS THE CHILD SUPPORT STANDARDS ACT. (2) A PARTY SEEKING SUPPORT FOR ANY CHILD(REN) RECEIVING FAMILY ASSISTANCE SHALL HAVE A CHILD SUPPORT ORDER REVIEWED AND ADJUSTED AT THE DIRECTION OF THE SUPPORT COLLECTION UNIT NO EARLIER THAN TWENTY-FOUR MONTHS AFTER SUCH ORDER IS ISSUED, LAST MODIFIED OR LAST ADJUSTED BY THE SUPPORT COLLECTION UNIT, WITHOUT FURTHER APPLICATION BY ANY PARTY. ALL PARTIES WILL RECEIVE A COPY OF THE ADJUSTED ORDER. (3) WHERE ANY PARTY FAILS TO PROVIDE, AND UPDATE UPON ANY CHANGE, THE SUPPORT COLLECTION UNIT WITH A CURRENT ADDRESS, AS REQUIRED BY SECTION FOUR HUNDRED FORTY-THREE OF THE FAMILY COURT ACT, TO WHICH AN ADJUSTED ORDER CAN BE SENT, THE SUPPORT OBLIGATION AMOUNT CONTAINED THEREIN SHALL BECOME DUE AND OWING ON THE DATE THE FIRST PAYMENT IS DUE UNDER THE TERMS OF THE ORDER OF SUPPORT WHICH WAS REVIEWED AND ADJUSTED OCCURRING ON OR AFTER THE EFFECTIVE DATE OF THE American LegalNet, Inc. www.FormsWorkFlow.com Form 5-1 page 4 ADJUSTED ORDER, REGARDLESS OF WHETHER OR NOT THE PARTY HAS RECEIVED A COPY OF THE ADJUSTED ORDER. ____________________________________________ Petitioner ____________________________________________ Print or type name _____________________________________________ Signature of Attorney, if any _____________________________________________ Attorney’s Name (Print or Type) _____________________________________________ _____________________________________________ _____________________________________________ Attorney’s Address and Telephone Number Dated: , . VERIFICATION STATE OF NEW YORK ) : ss.: COUNTY OF ) being duly sworn, says that (s)he is the Petitioner in the above-entitled proceeding and that the foregoing petition is true to (his)(her) own knowledge, except as to matters herein stated to be alleged on information and belief and as to those matters (s)he believes it to be true. ________________________ Petitioner Sworn to before me this day of , . _______________________________ (Deputy) Clerk of the Court Notary Public American LegalNet, Inc. www.FormsWorkFlow.com