Affidavit In Support Of Modification Of Support (Page 2 of 2) in pdf

Affidavit In Support Of Modification Of Support Page 2

Form 4-11b

Page 2

Needs of the children that are not being met [specify]:

Change in the ability of the payor to pay support [specify]:

Other [specify]:

Unless the parties have specifically agreed otherwise in a validly executed agreement or

stipulation, three years have passed since the order was entered, last modified or

adjusted.

Unless the parties have specifically agreed otherwise in a validly executed agreement or

stipulation, there has been a change in either party’s gross income by fifteen percent or

more since the order was entered, last modified or adjusted [state basis]:

Dated:

Signature of Petitioner

Sworn to before me this ____

Print or type name

day of

_______________________________

(Deputy) (Chief) Clerk of Court

Notary Public/Commissioner of Deeds

Signature of Attorney, if any

Attorney’s Name (Print or Type)

Attorney’s Address and Telephone Number

If incarceration is the basis for alleging substantial change in circumstances, so state and indicate whether or not the

incarceration resulted from a charge and/or conviction for nonpayment of child support or an offense against the custodial

parent or child who is the subject of the child support order. See Family Court Act §451(2)(a); Domestic Relations Law

§236B(9)(b)(2)(i).

This ground only applies to original or modified support orders entered on or after October 13, 2010.

Affidavit In Support Of Modification Of Support Page 2