Form 4-6 - Temporary Order Of Support (And Referral To Support Magistrate) (Page 7 of 9) in pdf

Form 4-6 - Temporary Order Of Support (And Referral To Support Magistrate) Page 7

Form 4-6 Page 7

; and it is further

G ORDERED that

, the non-custodial parent herein, pay the sum of $

as educational expenses by G direct payment to the educational provider

G other [specify]:

; and it is further

G ORDERED that [specify party or parties; check applicable box(es)]:

G purchase and maintain Q life and/or Q accident insurance policy in the

amount of [specify]:

(and/or)

G maintain the following existing Q life and/or Q accident insurance policy in the

amount of [specify]:

(and/or)

G assign the following as Q beneficiary Q beneficiaries [specify]:

to the following existing Q life and/or Q accident insurance policy or policies

[specify policy or policies and amount(s)]:

In the case of life insurance, the following shall be designated as irrevocable beneficiaries [specify]:

during the following time period [specify]:

In the case of accident insurance, the insured party shall be designated as irrevocable beneficiary

during the following time period [specify]:

The obligation to provide such insurance shall cease upon the termination of the duty of [specify

party]:

to provide support for each child;. and it is further

[IV-D Cases]: G ORDERED that when the person or family to whom family assistance is

being paid no longer receives family assistance, support payments shall continue to be made to the

Support Collection Unit, unless such person or family requests otherwise; and it is further

G ORDERED that the support obligor, the non-custodial parent, is directed to:

G seek employment

G participate in job training, employment counseling, or other programs designed to lead to

employment [specify program]:

; and it is further

[Judicial Orders Only]:

G ORDERED that Respondent shall have the following rights of visitation with respect to

the child(ren)[specify]:

; and it is further

ORDERED, that the issue of support is hereby referred to a support magistrate for final

determination pursuant to Sections 439 and 439-a of the Family Court Act; and it is further

[REQUIRED] IT IS FURTHER ORDERED that a copy of this order be provided

promptly by [check applicable box]:G Support Collection Unit ((IV-D cases: ) G Clerk of Court (non-

IV-D cases) to the New York State Case Registry of Child Support Orders established pursuant to

Inapplicable where support obligor is receiving SSI or social security disability benefits. See FCA §437-a.

Form 4-6 - Temporary Order Of Support (And Referral To Support Magistrate) Page 7