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Petition Approval Of Agreement Form. This is a New York form and can be use in Family Court Statewide.
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Tags: Petition Approval Of Agreement, 5-11, New York Statewide, Family Court
F.C.A§ 516
Form 5-11
(Petition - Approval of
Agreement)
9/2007
FAMILY COURT OF THE STATE OF NEW YORK
COUNTY OF
..............................................................................................
In the Matter of the Petition
for Approval of an Agreement
Docket No.
between
PETITION
(Approval of
Agreement)
Petitioner
S.S.#
and
Respondent
S.S.#
Pursuant to Section 516 of the
Family Court Act
..............................................................................................
TO THE FAMILY COURT:
The above named Petitioner respectfully shows that:
1. Petitioner resides at [specify]:1
2. Respondent resides at [specify]:2
3. A � male � female child � was born � is about to be born to the � Petitioner �
Respondent out of wedlock on or about
,
, and child resides with
at [specify unless ordered confidential, pursuant to Family Court Act
§154-b]:
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.nycourts.gov.
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Form 5-11 page 2
The name, date of birth, and social security number of the child involved are:
Name
Date of Birth
Social Security #
4. Petitioner and Respondent have entered into an agreement dated [specify]:
,
compromising and settling the claim of the Petitioner for support, medical care and education of
[specify child’s name]:
and a true copy of the agreement is annexed hereto and
made part hereof.
5. Petitioner and Respondent have consented to the entry of an order approving this
agreement.
6. No individual has to this point been adjudicated father of this child, either in this
court, or any other court, including a Native American court; and no individual has to this point
signed an Acknowledgment of Paternity admitting paternity for this child, (except [specify]:
)
7. No previous application has been made to any court or judge for the relief herein
requested (except [specify]:
)
WHEREFORE, Petitioner requests that the agreement annexed to this petition be approved
and confirmed pursuant to Section 516 of the Family Court Act and that its terms be incorporated and
made a part thereof.
Petitioner
Print or type name
Signature of Attorney, if any
Attorney’s Name (Print or Type)
Attorney’s Address and Telephone Number
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Form 5-11 page 3
VERIFICATION
STATE OF NEW YORK
COUNTY OF
)
)ss.:
)
, above named, being duly sworn, deposes and says
that (s)he is the Petitioner in the within action, that (s)he has read and knows the contents of the
foregoing Petition; that the same is true to (his) (her) own knowledge, except as to the matter therein
stated to be alleged on information and belief, and that as to those matters (s)he believes it to be true.
Sworn to before me this
day of
)
)
Petitioner
(Deputy) Clerk of the Court
Notary Public
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