Petition - Family Court Of The State Of New York (Page 2 of 4) in pdf

Form 4-3a page 2

[Check boxes if applicable; delete paragraphs 5 and/or 6 if inapplicable]:

6.Respondent is unlikely to make payments in accordance with the order of support

requested, because of G past lack of financial responsibility

G credit references G credit history G other [specify]:

7. Respondent has the following source of income: Gemployer Gincome payor, as

defined in CPLR Sec.5241(a), whose name and address are [specify]:

8. No previous application has been made to any judge or court, including a Native

American tribunal, or is presently pending before any judge or court, for the relief requested in this

petition (except

WHEREFORE, Petitioner requests an order for support directing Respondent to pay fair and

reasonable support payable to the Commissioner of Social Services or, in the event that the assignment

ends, payable to the ex-assignor, requiring Respondent to exercise the option of additional coverage

for health insurance in favor of (his) (her) above-named child(ren), and for such other and further relief

as the law provides.

NOTE:

(1) A COURT ORDER OF SUPPORT RESULTING FROM A PROCEEDING

COMMENCED BY THIS APPLICATION (PETITION) SHALL BE

ADJUSTED BY THE APPLICATION OF A COST OF LIVING

ADJUSTMENT AT THE DIRECTION OF THE SUPPORT COLLECTION

UNIT NO EARLIER THAN TWENTY-FOUR MONTHS AFTER SUCH

ORDER IS ISSUED, LAST MODIFIED OR LAST ADJUSTED, UPON THE

REQUEST OF ANY PARTY TO THE ORDER OR PURSUANT TO

PARAGRAPH (2) BELOW. SUCH COST OF LIVING ADJUSTMENT SHALL

BE ON NOTICE TO BOTH PARTIES WHO, IF THEY OBJECT TO THE

COST OF LIVING ADJUSTMENT, SHALL HAVE THE RIGHT TO BE

HEARD BY THE COURT AND TO PRESENT EVIDENCE WHICH THE

COURT WILL CONSIDER IN ADJUSTING THE CHILD SUPPORT ORDER

IN ACCORDANCE WITH SECTION FOUR HUNDRED THIRTEEN OF THE

FAMILY COURT ACT, KNOWN AS THE CHILD SUPPORT STANDARDS

ACT.

(2) A PARTY SEEKING SUPPORT FOR ANY CHILD(REN) RECEIVING

FAMILY ASSISTANCE SHALL HAVE A CHILD SUPPORT ORDER

REVIEWED AND ADJUSTED AT THE DIRECTION OF THE SUPPORT

COLLECTION UNIT NO EARLIER THAN TWENTY-FOUR MONTHS

AFTER SUCH ORDER IS ISSUED, LAST MODIFIED OR LAST ADJUSTED

BY THE SUPPORT COLLECTION UNIT, WITHOUT FURTHER

APPLICATION BY ANY PARTY. ALL PARTIES WILL RECEIVE A COPY

OF THE ADJUSTED ORDER.

(3) WHERE ANY PARTY FAILS TO PROVIDE, AND UPDATE UPON ANY

CHANGE, THE SUPPORT COLLECTION UNIT WITH A CURRENT

ADDRESS, AS REQUIRED BY SECTION FOUR HUNDRED

Pursuant to Section 111-g of the Social Services Law, where an order of support directs

that support payments be made to the support collection unit of a social services district, the

petition in such proceeding shall be deemed to be an application for support services.

Petition - Family Court Of The State Of New York Page 2

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