General Form 40 - Petition For Modification Of An Order Of Custody / Visitation Made By Nys Family Court/nys Supreme Court Page 3
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5a.
The information following applies to the current custody/visitation/parenting time order/judgment:
G Nassau County Family Court
Name of Court:
G NYS
County Family Court
G NYS
County Supreme Court
Date of Order/Judgment:
/
/
Name of Petitioner/Plaintiff:
Name of Respondent/Defendant:
Docket #/Index #:
Terms of the Order/Judgment (state the terms of who has custody of the children and the terms
of who has visitation or parenting time with the children):
Use an additional sheet of paper if necessary.
G Yes
G No
5b.
Is the current custody/visitation/parenting time order from a NYS Family Court?
If no, under the terms of the order/judgment, the court has not retained exclusive jurisdiction to
modify the order/judgment.
5c.
Check
one box below:
G
The order is a Nassau County Family Court order; three copies have been provided for
service.
G
A certified copy of the non-Nassau County Family Court custody/visitation/parenting time
order/judgment (with a certified copy of attachments) is attached and three additional
copies have been provided for service.
G
A certified copy of the non-Nassau County Family Court custody/visitation/parenting time
order/judgment (with a certified copy of attachments) was previously submitted to Nassau
County Family Court on a prior custody/visitation/parenting time matter filed after
January 1, 2013 and three copies have been provided for service.
6a.
Was the order entered in conjunction with a child protective dispositional order or a permanency
hearing order, directing custody with a relative or other non-parent, pursuant to the Family Court
G Yes
G No
Act §1055-b or §1089-a?
If yes, complete the following pertaining to the child protective case:
Family Court, County of
, Docket #
.
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