Fill and Sign the New York Objection to Form

F.C.A. §413, Art. 5-B Form 4-19 (Objection To Adjusted Order Issued by Support Collection Unit) 5/2015 FAMILY COURT OF THE STATE OF NEW YORK COUNTY OF ________________________________ (Commissioner of Social Services, Assignee, Docket No.________________ on behalf of , Assignor) OBJECTION TO AN ADJUSTED ORDER Petitioner, ISSUED BY THE SUPPORT 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 COUNTY WHERE THE ADJUSTED ORDER HAS BEEN FILED WITHIN 35 DAYS OF THE DATE THE ADJUSTED ORDER WAS MAILED TO YOU. YOU MUST SEND COPIES OF SUCH OBJECTIONS TO THE SUPPORT COLLECTION UNIT AND TO THE OPPOSING PARTY OR PARTIES. YOU MUST PROVIDE PROOF THAT THE OPPOSING PARTY OR PARTIES AND THE SUPPORT COLLECTION UNIT HAVE BEEN PROVIDED WITH COPIES OF THE OBJECTIONS (SEE AFFIDAVIT OF SERVICE ATTACHED). __________________________________________________________________________________ USE THIS SECTION IF YOU ARE OBJECTING TO AN ADJUSTED ORDER ISSUED AS A RESULT 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 following grounds [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 RESULTING FROM A REVIEW OF AN ORDER ISSUED PRIOR TO SEPTEMBER 15, 1989 THAT HAD NOT BEEN REVIEWED, ADJUSTED OR MODIFIED SINCE THAT DATE: I 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 Number Date: , . THIS SECTION IS REQUIRED IN ALL CASES: AFFIDAVIT OF SERVICE ___________________________________________ Petitioner against Docket No. _____________ ____________________________________________ Respondent STATE OF NEW YORK ) : ss.: COUNTY OF ) I, _________________________, being duly sworn, depose and say: I have served this Objection to an Adjusted Order upon the [check applicable box]: Support Collection Unit NYC HRA Office of ☐ ☐ Legal Affairs 1 at [specify]: and upon [specify name of opposing party or parties]: by mail in person [note: service in person must be made by non-party to the case] on [specify date]: ☐ ☐ ___________________________________ Sworn to before me this day of Signature of Person Serving Objection 1 In New York City, service of this objection may be made upon the New York City Human Resources Administration Office of Legal Affairs, Child Support Litigation Unit, 150 Greenwich Street, 38 th Floor, New York, NY 10007 , which represents the Support Collection Unit in these matters. _______________________________ (Notary Public) (Deputy) Clerk