Petition - Family Court Of The State Of New York
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4F.C.A. §§ 415, 416, 421, 422,
Form 4-3a
432, 424, 571; S.S.L. §§ 101, 102
(Support)
C.P.L.R. 5242
6/2012
[NOTE: Personal Information Form 4-5/5-1d,
containing social security numbers of parties and
dependents, must be filed with this Petition]
FAMILY COURT OF THE STATE OF NEW YORK
COUNTY OF
...................................................................................
In the Matter of a Proceeding for
Docket No.
Support under Article 4 of the Family Court Act
(Commissioner of Social Services, Assignee
on behalf of
, Assignor)
Petitioner,
PETITION
(Commissioner)
-against-
Respondent.
...........................................................................
TO THE FAMILY COURT:
The undersigned Petitioner respectfully alleges that:
1. Petitioner is Commissioner of Social Services whose official address is
in the County of
, State of New York and is authorized to originate this proceeding (as
assignee) pursuant to the Social Services Law and the Family Court Act of the State of New York.
2. The assignor is authorized to originate a support proceeding but has assigned her/his right
to do so to the Commissioner of Social Services pursuant to the Social Services Law of the State of
New York. In the event the assignment ends the assignor may pursue support and may seek an order of
support.
3. (Upon information and belief) (Assignor) and Respondent were married at
on
,
.)
4. Respondent is chargeable with the support of the following:
Name
Date of Birth
Spouse:
Child(ren)
5. (Upon information and belief) Respondent, on or about
, , and since that date,
has failed to provide fair and reasonable support for the above-named dependent(s) according to
Respondent's means and earning capacity.
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