Support Collection Unit 4 Information Sheet

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SUPREME COURT OF THE STATE OF NEW YORK
1
COUNTY OF
--------------------------------------------------------------------x
2
Plaintiff,
3
Index No.
-against-
SUPPORT COLLECTION UNIT
INFORMATION SHEET
4
Defendant.
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The following information is required pursuant to Section 240(1) of the Domestic Relations
Law:
PLAINTIFF:
5
Address:
Date of Birth
SS #:
DEFENDANT:
6
Address:
Date of Birth
SS #:
Date and Place of Marriage:
7
Plaintiff OR
Defendant is the custodial parent and
is OR
is not receiving public
8
assistance.
9
UNEMANCIPATED CHILDREN:
Name
Date of Birth
SUPPORT: Maintenance $
per week OR
bi-weekly OR
per month
Child Support $
per week OR
bi-weekly OR
per month
Total Support $
per week OR
bi-weekly OR
per month
10
Support payments are to be made to the Support Collection Unit for the benefit of
Plaintiff OR
Defendant OR
Third Party.
11
If third party, list name and address:
12
Non-custodial parent’s employer:
Address:
13
Dated:
(Form UD-8a - Rev. 5/12)

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