Fill and Sign the Form 4 19

F.C.A. §413, Art. 5-BForm 4-19 (Objection To AdjustedOrder Issued by SupportCollection Unit)5/2015FAMILY COURT OF THE STATE OF NEW YORKCOUNTY OF ________________________________(Commissioner of Social Services, Assignee, Docket No.________________on behalf of , Assignor)OBJECTION TO AN ADJUSTED ORDERPetitioner,ISSUED BY THESUPPORT COLLECTION UNIT-against-Respondent.___________________________________________NOTICE:IF YOU OBJECT TO AN ADJUSTED ORDER ISSUED BY THE SUPPORT COLLECTION UNIT,THIS FORM MUST BE FILED WITH THE CLERK OF THE FAMILY COURT IN THE COUNTYWHERE THE ADJUSTED ORDER HAS BEEN FILED WITHIN 35 DAYS OF THE DATE THEADJUSTED ORDER WAS MAILED TO YOU. YOU MUST SEND COPIES OF SUCHOBJECTIONS TO THE SUPPORT COLLECTION UNIT AND TO THE OPPOSING PARTY ORPARTIES. YOU MUST PROVIDE PROOF THAT THE OPPOSING PARTY OR PARTIES ANDTHE SUPPORT COLLECTION UNIT HAVE BEEN PROVIDED WITH COPIES OF THEOBJECTIONS (SEE AFFIDAVIT OF SERVICE ATTACHED).__________________________________________________________________________________USE THIS SECTION IF YOU ARE OBJECTING TO AN ADJUSTED ORDER ISSUED AS ARESULT OF A COST OF LIVING ADJUSTMENT (COLA):I am a Party in the above-entitled proceeding and object to the adjusted order (copy attached)resulting from application of a cost of living adjustment by the Support Collection Unit upon the followinggrounds [specify]:___________________________________________________________________________________________________________________________________________________________________ ___________________________________Signature (Petitioner or Respondent)___________________________________Print or Type Name__________________________________Signature of Attorney, if any_________________________________(Attorney’s name) Print or Type __________________________________ __________________________________Dated: , . __________________________________Attorney’s Address and Telephone Number__________________________________________________________________________________USE THIS SECTION IF YOU ARE OBJECTING TO AN ADJUSTED ORDER RESULTINGFROM A REVIEW OF AN ORDER ISSUED PRIOR TO SEPTEMBER 15, 1989 THAT HAD NOTBEEN REVIEWED, ADJUSTED OR MODIFIED SINCE THAT DATE: Form 4-19 Page 2I am a Party in the above-entitled proceeding and object to the adjusted order (copy attached)received by me upon the following grounds [specify]:_________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________Petitioner_____________________________Print or type name_____________________________Signature of Attorney, if any_____________________________Attorney’s Name (Print or Type)_______________________________________________________________________________________Attorney’s Address and Telephone NumberDate: , .THIS SECTION IS REQUIRED IN ALL CASES: AFFIDAVIT OF SERVICE___________________________________________Petitioner againstDocket No. _________________________________________________________RespondentSTATE OF NEW YORK ) : ss.:COUNTY OF )I, _________________________, being duly sworn, depose and say: I have served this Objection toan Adjusted Order upon the [check applicable box]: QSupport Collection Unit Q NYC HRA Office ofLegal Affairs1 at [specify]: and upon [specify name of opposing party or parties]: Qby mail Qin person [note: service in person must be made by non-party to the case] on [specify date]:___________________________________Sworn to before me this day ofSignature of Person Serving Objection _______________________________ (Notary Public) (Deputy) Clerk1 In New York City, service of this objection may be made upon the New York City Human ResourcesAdministration Office of Legal Affairs, Child Support Litigation Unit, 150 Greenwich Street, 38th Floor, New York, NY10007, which represents the Support Collection Unit in these matters.