C.P.L.R 5241, 5252
Form 4-8a
(Income Execution
Clerk of Court)
9/2006
FAMILY COURT OF THE STATE OF NEW YORK
COUNTY OF
............................................................................................
In the Matter of a Proceeding for Support
Docket No.
Under Article
of the Family Court Act
Petitioner
INCOME
EXECUTION
S.S.#: xxxx-xx-
FOR SUPPORT
-against-
ENFORCEMENT
(Clerk of Court)
Respondent.
S.S.#: xxxx-xx-
....................................................................................................
TO:
(employer) (income payor)
WHEREAS an order of support was entered in the
Court, County of
, of the State of
on the
day of
,
, directing that the amount of $
shall be paid
Q weekly, Q every two weeks, Q monthly, Q twice per month, Q quarterly by [specify debtor]:
to [specify creditor]:
; and
WHEREAS the above payments have not been made and there is due and owing to the creditor
the amount of $
in arrears; and
WHEREAS, the debtor is Gemployed by [specify]:
, whose
Gcurrently is receiving or will receive income
address is
from [specify]:
, whose address is
;
NOW THEREFORE, YOU ARE DIRECTED to deduct from the amount payable to said debtor
Q weekly, Q every two
now and henceforth, until further notice, the sum of $
weeks, Q monthly, Q twice per month, Q quarterly to be applied to insure compliance with the
direction in said order of support, and a further sum of $
to be applied to the reduction of
arrears until the amount of $
in arrears is paid in full; and to remit the amount so deducted
to the following address:
within ten days of the date that Respondent is paid; and
YOU ARE FURTHER DIRECTED TO notify the undersigned promptly if and when the debtor
Q ceases to be in your employ Q is no longer the recipient of income and provide the debtor's address
(and the name and address of the new employer, if known).