Form 4-11a - Support-Order Extending, Modifying Or Terminating Order Of Support Made By Family Court Or Another Court Page 4
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11Form 4-11a page 4
basic child support obligation (is) (are) [specify]:
;
G The Court approves the parties' agreement to deviate from the basic child support
obligation for the following reasons: [specify; see Family Court Act Section 413(1)(f)]:
;
The name, address and telephone number of
Q Respondent’s
Q (modification only): Petitioner’s
current employer(s), are:
NAME
ADDRESS
TELEPHONE
NOW, therefore, it is hereby
G ORDERED that the petition for modification is DENIED.
OR
G ORDERED that the Q judgment Qorder, dated
,
, is
TERMINATED;
G ORDERED that the Qjudgment Q order dated
,
, is CONTINUED
until further order of this Court;
G ORDERED that the Q judgment Qorder, dated
,
, is MODIFIED in
the following respects [specify]:
G AND the defaulting party having Q shown Qfailed to show good cause for failure to
make an application for relief from the judgment or order directing payment prior to the accrual of
the arrears, it is
G ORDERED that arrears in the amount of $
are Q annulled Qreduced to $
Q fixed at the full amount of $
; and it is further
G ORDERED that judgment be entered in favor of the Petitioner against the Respondent
, plus interest [CPLR 5004] from
in the amount of $
,
, in the
plus costs and disbursements in the amount of $
amount of $
,
, for a total
sum of $
; and it is further
G ORDERED and ADJUDGED that the above-named Q Respondent Q Petitioner is
responsible for the support so ordered from the date of the filing of the petition to the date of this
Order Q less the amount of $
and that the Q Respondent Q Petitioner shall
already paid,
Q weekly, Q every
pay the sum of $
as follows: $
immediately, $
two weeks, Q twice per monthly, Q quarterly, to [check applicable box]:
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