Fill and Sign the Fca467 549 651 652654 Drl 240 General Form 17

DRL §§76-h(5); 254;Exec. L. §108General Form 21a FCA § 154-(b); 818; 1015Address Confidentiality Order 9/2012 FAMILY COURT OF THE STATE OF NEW YORKCOUNTY OF............................................................................... Petitioner -against- ADDRESS CONFIDENTIALITYORDERDOCKET NO. Respondent..............................................................................An affidavit having been filed in this Court requesting that a party or child(ren)’s address(es)and/or other identifying information not be disclosed,NOW, it is herebyORDERED, that the present and all future address(es) and/or other identifying information of[specify name]: and child(ren)[specify name(s)]: not be disclosed in any pleading, document, or proceeding in this Court; and it is furtherORDERED, that the following person is designated as the agent for service of process and papersin this case [specify name and address]:G Clerk of Court G Attorney [specify name & address]:G NYS Department of State [Note: participation expires on [specify date]: ]G Other [specify name & address]: ORDERED, that [specify name of protected party]: must informthe above- named agent for service of process and papers promptly of all changes of address.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.Dated:, . ENTER ________________________________________ G Judge of the Family Court GSupport MagistrateCheck applicable box:G Order mailed on [specify date(s) and to whom mailed ]:___________________________G Order received in court on [specify date(s) and to whom given]:_____________________ Form GF-21a Page 2IF THIS ORDER IS ENTERED BY A JUDGE, 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, 30 DAYS AFTER SERVICE BY A PARTY OR THE ATTORNEY FOR THE CHILD UPON THE APPELLANT OR 35 DAYS FROM THE DATE OF MAILING OF THE ORDER TO APPELLANT BY THE CLERK OF COURT,WHICHEVER IS EARLIEST.IF THIS ORDER IS ENTERED BY A SUPPORT MAGISTRATE, SPECIFIC WRITTEN OBJECTIONS TO THIS ORDER MAY BE FILED WITH THIS COURT WITHIN 30 DAYS OF THE DATE THE ORDER WAS RECEIVED IN COURT OR BY PROFESSIONAL SERVICE, OR IF THE ORDER WAS RECEIVED BY MAIL, WITHIN 35 DAYS OF THE MAILING OF THE ORDER.