Fill and Sign the 455 Art 490203389 Form

F.C.A.§ 455, Art.5-BForm 4-15a (Order on Petition for Relief from Support Payments and Commitment) 8/2010 At a term of the Family Court of the State of New York, held in and for the County of , at , New York on , . P R E S E N T: Hon. Judge, In the Matter of a Proceeding for Support under Article of the Family Court Act Docket No. Petitioner, ORDER ON PETITION -against- FOR RELIEF FROM SUPPORT PAYMENTS Respondent. AND COMMITMENT The petition of [specify]: dated having been filed in this Court alleging that the above-named Respondent is financially unable to comply with an order of support entered in this Court on , and The matter having-duly come on to be heard before this Court, NOW, after examination and inquiry into the facts and circumstances of the case, it is hereby ADJUDGED that Respondent is financially ”able ” unable to comply with the order of support; and it is therefore ORDERED that the application for relief is ”GRANTED ”DENIED; [check applicable boxes]: ” AND Respondent having shown good cause for failure to make application for relief from the judgment or order directing payment prior to the accrual or arrears, it is ”ORDERED that arrears in the amount of [specify]: ___________are ” annulled ” reduced to [specify]: ___________________; and it is further ”ORDERED that the order of support is hereby modified as follows: Form 4-15a page 2 ” ORDERED that the order of commitment is hereby ”continued ”suspended ”revoked. Dated: ENTER Judge of the Family Court PURSUANT TO SECTION 1113 OF THE FAMILY COURT ACT, AN APPEAL FROM THIS ORDER MUST BE TAKEN WITHIN 30 DAYS OF RECEIPT OF THE ORDER BY APPELLANT IN COURT, 35 DAYS FROM THE DATE OF MAILING OF THE ORDER TO APPELLANT BY THE CLERK OF COURT, OR 30 DAYS AFTER SERVICE BY A PARTY OR THE ATTORNEY FOR THE CHILD UPON THE APPELLANT, WHICHEVER IS EARLIEST. Check applicable box: ‘ Order mailed on [specify date(s) and to whom mailed]:_______________________ ‘ Order received in court on [specify date(s) and to whom given]:_________________