Fill and Sign the 111 K 490203441 Form

FCA §565 Form 5-4 S.S.L. 111-k (Notice of Motion- [ NOTE : Confidential Information Form 4-5/5-1-d, Challenge to Testing containing social security numbers of parties and Directive) dependents, must be filed with this Petition] 8/2010 FAMILY COURT OF THE STATE OF NEW YORK COUNTY OF ................................................................................ In the Matter of a Paternity Proceeding Involving Docket No. Name of Child NOTICE OF MOTION TOCHALLENGE GENETIC MARKER OR DNA Name of Mother TESTING DIRECTIVE Name of Alleged Father................................................................................. TO: ( Local Social Services Official) PLEASE TAKE NOTICE, that upon the annexed affidavit of sworn to on , a motion will be made before the County Family Court at on or as soon thereafter as the parties can be heard for an order directing that not be required to submit to the administration and analysis of Genetic Marker or DNA tests. _____________________________Applicant _____________________________ Print or type name _____________________________ Signature of Attorney, if any _____________________________ Attorney’s Name (Print or Type) Form 5-4 page 2 _____________________________ __________________________________________________________ Attorney’s Address and Telephone Number Dated: AFFIDAVIT IN SUPPORT OF MOTION TO CHALLENGE GENETIC MARKER OR DNA TESTING DIRECTIVE STATE OF NEW YORK ) S.S.: COUNTY OF ) being duly sworn deposes and states: 1. That I was served with an order requiring me to submit to a Genetic Marker or DNA test on at by a Social Services official concerning the paternity of a child born out of wedlock to on (A copy of said order is attached.)2. That a petition to establish paternity (has) (has not) been filed concerning said child. (If filed, state Docket Number .)3. That a Genetic Marker or DNA test should not be ordered in this case for the following reason(s) . Applicant Print or type name Sworn to before me this day of . (Deputy) Clerk of the Court Notary Public