Form 4-6a - Referral To Support Magistrate And Temporary Order Of Support1 printable pdf download

Form 4-6a - Referral To Support Magistrate And Temporary Order Of Support1

F.C.A.§§ 413, 416, 433, 434,

Form 4-6a

439, 439-a, 440;

(Referral to Support

D.R.L

.§ 240

Magistrate and Temporary

Order of Support)

5/2015

At a term of the Family Court of the

State of New York, held in and for the

County of

New York

PRESENT:

Hon.

Judge

.....................................................................

In the Matter of a Proceeding under Article

Docket No.

of the Family Court Act

REFERRAL TO SUPPORT

MAGISTRATE and TEMPORARY

Petitioner,

ORDER OF SUPPORT

S.S.#: xxxx-xx-

-against-

Respondent

S.S.#: xxxx-xx-

......................................................................

NOTICE: YOUR WILLFUL FAILURE TO OBEY THIS ORDER MAY RESULT IN

COMMITMENT TO JAIL FOR A TERM NOT TO EXCEED SIX MONTHS FOR

CONTEMPT OF COURT OR PROSECUTION FOR CRIMINAL NON-SUPPORT.

YOUR FAILURE TO OBEY THIS ORDER MAY RESULT IN SUSPENSION OF

YOUR DRIVER’S LICENSE, STATE-ISSUED PROFESSIONAL, TRADE, BUSINESS

AND OCCUPATIONAL LICENSES AND RECREATIONAL AND SPORTING

LICENSES AND PERMITS; AND IMPOSITION OF REAL OR PERSONAL

PROPERTY LIENS.

A petition in this proceeding, dated:

having been filed in this

Court, and it appearing that the Court has jurisdiction over the parties and that there is an issue of

support; and

Respondent having appeared before this Court to answer the petition and to show why an

order of Support and other relief requested in the petition should not be granted; and Respondent, after

having been advised of the right to counsel, having Q denied Q admitted the allegations of the petition;

The name, address and telephone number of Respondent’s current employer(s) are:

NAME

ADDRESS

TELEPHONE

For use where original petition is not filed pursuant to Article 4.

Form 4-6a - Referral To Support Magistrate And Temporary Order Of Support1

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