SUPREME COURT OF THE STATE OF NEW YORK COUNTY OF -------------------------------------------------------------X Plaintiff, Index No.: -against- SUPPORT REFERRAL ORDER Defendant. ------------------------------------------------------------X J.: IT IS HEREBY ORDERED , that the Order of this Court dated is (continued) (terminated) (modified as indicated below); it is further ORDERED , that the plaintiff / defendant is hereby directed to pay to the County Support Collection Unit the sum of $ (weekly) (biweekly) (monthly) for the current careand support of spouse and $ for the child(ren), effective ; it is further ORDERED , that the arrears are established in the amount of $ as of , and the plaintiff / defendant is directed to pay at the rate of $ (weekly) (biweekly)(monthly) towards said amount; it is further ORDERED , that the plaintiff / defendant shall present a copy of this Support Referral Order to the Dated: Justice Supreme Court Support Referral Order September 2004 American LegalNet, Inc. www.USCourtForms.com