Form 4-19b - Order Determining Objections To Adjusted Order Page 3
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10Form 4-19b Page 3
Section 413(1)(h) of the Family Court Act, that:
a. The parties have been advised of the provisions of Family Court Act §413(1);
b. The unrepresented party, if any, has received a copy of the child support standards chart
promulgated by the Commissioner of the N.Y.S. Office of Temporary and Disability Assistance
pursuant to Section 111-i of the Social Services Law;
c. The basic child support obligation as defined in Family Court Act Section 413(1)
presumptively results in the correct amount of child support to be awarded;
d. The basic child support obligation in this case is $__________ G weekly G every two
weeks G monthly Gtwice per month G quarterly; and
e. The parties' reason(s) for agreeing to child support in an amount different from the 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)]:
5. The name(s), address(es) and telephone number(s) of Respondent's current employer(s)
(is)(are):
NAME
ADDRESS
TELEPHONE NUMBER
NOW, therefore, it is [check applicable box(es)]:
G ORDERED that after application of the child support standards as set forth in §413 of
the Family Court Act it has been determined that no adjustment to the order, dated
is
appropriate and, therefore, no order of adjustment is entered.
OR
G ORDERED that after application of the child support standards as set forth in section
§413 of the Family Court Act a new order of support is entered as follows:
; and it is further
G ORDERED and ADJUDGED that the above-named Respondent is responsible for the
support so ordered from the date G of the determination of the objection G the cost of living
adjustment would have been effective, __________________, to the date of this order, less the
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