Fill and Sign the New York Income Execution Form

CPLR § 5241 (b) Form 4-8 [ NOTE : Personal Information Form 4-5/5-1d, (Application for Income containing social security numbers of parties and Withholding Order for dependents, must be filed with this Petition] Support Enforcement (Clerk of Court) 6/2012 FAMILY COURT OF THE STATE OF NEW YORK COUNTY OF ...................................................................................... In the Matter of a Proceeding for Support under Article 4 of the Family Court Act Docket No. Petitioner (Creditor), APPLICATION FOR INCOME -against- WITHHOLDING ORDER FOR SUPPORT Respondent (Debtor) ENFORCEMENT (Clerk of Court) ....................................................................................... TO THE CLERK OF THE FAMILY COURT: The undersigned respectfully alleges that: 1. was the Petitioner and that was the Respondent in the above-entitled proceeding. 2. By an order of support dated , Respondent was ordered to pay support to [specify]: as follows: (attach copy of order of support) . 3. (Upon information and belief) Respondent is in default of the order in that [specify]: and arrears of $ are due and owing as of (date). 4. Respondent is □employed by □receives income from [specify]: NAME ADDRESS Wherefore applicant requests the Clerk of Family Court, County of [specify]: to issue an Income Withholding Order (IWO) for Support directed to the New York State Child Support Processing Center pursuant to Section 5241(b) of the Civil Practice Law and Rules. (Applicant) ___________________________________ Petitioner ___________________________________ Print or type name ___________________________________ Signature of Attorney, if any ___________________________________ Attorney’s Name (Print or Type) ___________________________________ ___________________________________ ___________________________________ Attorney’s Address and Telephone Number