Fill and Sign the Upon a Showing of I a Substantial Change in Circumstances or Ii that Form

1 1 At the Matrimonial/IAS Part _____ of New York State Supreme Court at 2 2 the Courthouse, ________________ 3 3 County, on ___________________. Present: 44 Hon. Justice/Referee ------------------------------------------------------------------X 55 66 Index No.: Plaintiff, Calendar No.: -against- Social Security No.: JUDGMENT OF DIVORCE 7 7 Defendant. -----------------------------------------------------------------X EACH PARTY HAS A RIGHT TO SEEK A MODIFICATION OF THE CHILD SUPPORT ORDER UPON A SHOWING OF: (I) A SUBSTANTIAL CHANGE IN CIRCUMSTANCES; OR (II) THAT THREE YEARS HAVE PASSED SINCE THE ORDER WAS ENTERED, LAST MODIFIED OR ADJUSTED; OR (III) THERE HAS BEEN A CHANGE IN EITHER PARTY'S GROSS INCOME BY FIFTEEN PERCENT OR MORE SINCE THE ORDER WAS ENTERED, LAST MODIFIED, OR ADJUSTED; HOWEVER, IF THE PARTIES HAVE SPECIFICALLY OPTED OUT OF SUBPARAGRAPH (II) OR (III) OF THIS PARAGRAPH IN A VALIDLY EXECUTED AGREEMENT OR STIPULATION, THEN THAT BASIS TO SEEK MODIFICATION DOES NOT APPLY. 88 THE FOLLOWING NOTICE IS  APPLICABLE OR  NOT APPLICABLE NOTICE REQUIRED WHERE PAYMENTS THROUGH SUPPORT COLLECTION UNIT NOTE: (1) THIS ORDER OF CHILD SUPPORT SHALL BE ADJUSTED BY THE APPLICATION OF A COST OF LIVING ADJUSTMENT AT THE DIRECTION OF THE SUPPORT COLLECTION UNIT NO EARLIER THAN TWENTY-FOUR MONTHS AFTER THIS ORDER IS ISSUED, LAST MODIFIED OR LAST ADJUSTED, UPON THE REQUEST OF ANY PARTY TO THE ORDER OR PURSUANT TO PARAGRAPH (2) BELOW. UPON APPLICATION OF A COST OF LIVING ADJUSTMENT AT THE DIRECTION OF THE SUPPORT COLLECTION UNIT, AN ADJUSTED ORDER SHALL BE SENT TO THE PARTIES WHO, IF THEY OBJECT TO THE COST OF LIVING ADJUSTMENT, SHALL HAVE THIRTY-FIVE (35) DAYS FROM THE DATE OF MAILING TO SUBMIT A WRITTEN OBJECTION TO THE COURT INDICATED ON SUCH ADJUSTED ORDER. UPON RECEIPT OF SUCH WRITTEN OBJECTION, THE (UD-11 Rev. 1/31/18) -1- COURT SHALL SCHEDULE A HEARING AT WHICH THE PARTIES MAY BE PRESENT TO OFFER EVIDENCE WHICH THE COURT WILL CONSIDER IN ADJUSTING THE CHILD SUPPORT ORDER IN ACCORDANCE WITH THE CHILD SUPPORT STANDARDS ACT. (2) A RECIPIENT OF FAMILY ASSISTANCE SHALL HAVE THE CHILD SUPPORT ORDER REVIEWED AND ADJUSTED AT THE DIRECTION OF THE SUPPORT COLLECTION UNIT NO EARLIER THAN TWENTY-FOUR MONTHS AFTER SUCH ORDER IS ISSUED, LAST MODIFIED OR LAST ADJUSTED WITHOUT FURTHER APPLICATION BY ANY PARTY. ALL PARTIES WILL RECEIVE A COPY OF THE ADJUSTED ORDER. (3) WHERE ANY PARTY FAILS TO PROVIDE, AND UPDATE UPON ANY CHANGE, THE SUPPORT COLLECTION UNIT WITH A CURRENT ADDRESS, AS REQUIRED BY SECTION TWO HUNDRED FORTY-B OF THE DOMESTIC RELATIONS LAW, TO WHICH AN ADJUSTED ORDER CAN BE SENT, THE SUPPORT OBLIGATION AMOUNT CONTAINED THEREIN SHALL BECOME DUE AND OWING ON THE DATE THE FIRST PAYMENT IS DUE UNDER THE TERMS OF THE ORDER OF SUPPORT WHICH WAS REVIEWED AND ADJUSTED OCCURRING ON OR AFTER THE EFFECTIVE DATE OF THE ADJUSTED ORDER, REGARDLESS OF WHETHER OR NOT THE PARTY HAS RECEIVED A COPY OF THE ADJUSTED ORDER. 99 This action was submitted to  the referee OR  this court for  consideration this day of OR for  inquest on this day of . 1010 The Defendant was served  personally OR  pursuant to court order dated  within OR  outside the State of New York. 1111 Plaintiff presented a  Verified Complaint and Affidavit of Plaintiff constituting the facts of the matter OR  Summons With Notice and Affidavit of Plaintiff constituting the facts of the matter. 1212 The Defendant has  not appeared and is in default OR  appeared and waived his or her right to answer OR  filed an answer or amended answer withdrawing any prior pleadings and neither admitting nor denying the allegations in the complaint and consenting to the entry of judgment OR  the parties settled the ancillary issues by  written stipulation OR  oral stipulation on the record dated . 1313 The Court accepted  written OR  oral proof of non-military status. (UD-11 Rev. 1/31/18) -2- 1414 The Plaintiff’s address is , and social security number is . The Defendant’s address is , and social security number is . 1515 Now on motion of ________________________, the  attorney for Plaintiff OR  Plaintiff , it is: 1616 ORDERED AND ADJUDGED that the Referee’s Report, if any, is hereby confirmed; and it further 1717 ORDERED, ADJUDGED AND DECREED that the application of plaintiff is hereby granted to dissolve the marriage between , plaintiff, and , defendant, by reason of:  (a) the cruel and inhuman treatment of  Plaintiff by Defendant OR  Defendant by Plaintiff pursuant to D.R.L. §170(1); and/or  (b) the abandonment of  Plaintiff OR  Defendant by  Plaintiff OR  Defendant, for a period of one or more years, pursuant to D.R.L. §170(2); and/or  (c) the confinement of  Plaintiff OR  Defendant in prison for a period of three or more consecutive years after the marriage of Plaintiff and Defendant, pursuant to D.R.L. §170(3); and/or  (d) the commission of an act of adultery by  Plaintiff OR  Defendant, pursuant to D.R.L. §170(4); and/or  (e) the parties having lived separate and apart pursuant to a decree or judgment of separation dated for a period of one or more years after the granting of such decree or judgment, pursuant to D.R.L. §170(5); and/or (f) the parties having lived separate and apart pursuant to a Separation Agreement dated in compliance with the provisions of D.R.L. §170(6); and/or  (g) the relationship between Plaintiff and Defendant has broken down irretrievably for a period of at least six months pursuant to D.R.L. §170(7); and (UD-11 Rev. 1/31/18) -3- 1818 The requirements of D.R.L. §240 1(a-1) have been met and the Court having considered the results of said inquiries, it is ORDERED AND ADJUDGED that  Plaintiff OR  Defendant OR  third party, namely: shall have custody of the minor child(ren) of the marriage, i.e.: 1919 Name Date of Birth Social Security No. ______________________________ _________________ _________________ ______________________________ _________________ _________________ ______________________________ _________________ _________________ ______________________________ _________________ _________________ OR  There are no minor children of the marriage ; and 2020 The requirements of D.R.L. §240 1 (a-1) have been met and the Court having considered the results of said inquires, it is ORDERED AND ADJUDGED that  Plaintiff OR  Defendant shall have visitation with the minor child(ren) of the marriage  in accordance with the parties’ settlement agreement OR  according to the following schedule : OR  Visitation is not applicable ; and it is further 2121 ORDERED AND ADJUDGED that the existing County, Court order(s) under  Index No.. OR  Docket No. as to  custody OR  visitation shall continue; OR  There are no court orders with regard to custody or visitation to be continued ; and it is further 2222 ORDERED AND ADJUDGED that  Plaintiff OR  Defendant shall pay to  Plaintiff OR  Defendant OR  third party, namely: , as and for the support of the parties’ unemancipated children of the marriage, the sum of $ per , pursuant to an existing order issued by the County, Court, under  Index OR  Docket Number , the terms of which are hereby continued. OR  There are no orders from other courts to be continued ; and it is further (UD-11 Rev. 1/31/18) -4- 2323 ORDERED AND ADJUDGED that: A)  Pursuant to the  agreement of the parties  Court’s decision the shall pay to  Plaintiff  Defendant  Plaintiff  Defendant the sum of $______________ as and for maintenance :  per week  bi-weekly  semi-monthly  monthly  payments to be made as set forth in the agreement;  commencing on the ____ day of ___________,____, and continuing until the ____ day of ________,____; month year month year Payment shall be  a direct payment,  by an Income Deduction Order issued simultaneously herewith; ===============================OR============================== B)  that there is no award of maintenance per the court’s decision;  that there is no request for maintenance;  that the guideline award of maintenance under the Maintenance Guidelines Law (L.2015 c. 269), if applicable, was zero. and it is further; ===============================OR============================== C) Pursuant to the court’s decision for cases commenced before 1/25/16 the  Plaintiff  Defendant shall pay to  Plaintiff  Defendant the sum of  $ ______ per week;  $ ______bi-weekly;  $_________semi- monthly  $________per month as and for maintenance commencing on the ____ day of ___________,____, and continuing until the ____ day of ________,____; month year Payment shall be  a direct payment,  by an Income Deduction Order issued simultaneously herewith; ===============================OR============================== D) Pursuant to the court’s decision for cases commenced on or after 1/25/16 the  Plaintiff  Defendant shall pay to  Plaintiff  Defendant the sum of  $ ______ per week;  $ ______bi-weekly;  $_________semi- monthly  $________per month as and for maintenance (the “Award”) commencing on the ____ day of ___________,____, and continuing until the ____ day of ________,____; month year (UD-11 Rev. 1/31/18) -5- Payment shall be  a direct payment,  by an Income Deduction Order issued simultaneously herewith; The guideline award of maintenance under the Maintenance Guidelines Law is $________ For the reasons stated in the Findings of Fact and Conclusions of Law, which are incorporated here in by reference: (Check the applicable boxes:)  The Award includes an award on income of maintenance payor up to $184,000 per year. In computing said award, the Court applied the Maintenance Guidelines Law (L.2015, c.269) ; OR  the court adjusted the guideline award of maintenance due under the Maintenance Guidelines Law because it is unjust and inappropriate. The Award includes maintenance on income of maintenance payor in excess of $184,000 per year OR  The Award does not include maintenance on income of maintenance payor in excess of $184,000 per year. 2424 ORDERED AND ADJUDGED that  Plaintiff OR  Defendant shall pay to  Plaintiff OR  Defendant OR  third party, namely: , OR  because a party is already receiving child support services or an application has been made for such services, through the NYS Child Support Processing Center, PO Box 15363, Albany, NY 12212-5363; as and for the support of the parties’ unemancipated child(Ren) of the marriage, namely: Name Date of Birth ______________________________ _________________ ______________________________ _________________ ______________________________ _________________ ______________________________ _________________ the sum of $  per week OR  bi-weekly OR  semi-monthly  per month, commencing on , and to be paid  directly to  Plaintiff OR  Defendant OR  third party, namely: , OR  through the NYS Child Support Processing Center, PO Box 15363, Albany, NY 12212-5363, together with such dollar amounts or percentages for  child care OR  education OR  health care as set forth below in accordance with  the Court’s decision OR  the parties’ Settlement Agreement. OR  This section is not applicable because there are no unemancipated children of the marriage; Such Settlement Agreement, if applicable, is in compliance with D.R.L. §240(1-b)(h) because: The parties have been advised of the provisions of D.R.L. Sec. 240(1-b); the unrepresented party, if any, has received a copy of the Child Support Standards Chart promulgated by the Commissioner of Social Services pursuant to Social Services Law Sec. 111-I; (UD-11 Rev. 1/31/18) -6- the basic child support obligation, as defined in D.R.L. Sec. 240(1-b), presumptively results in the correct amount of child support to be awarded, and the agreed upon amount substantially conforms to the basic support obligation attributable to the non-custodial parent; the amount awarded is neither unjust nor inappropriate, and the Court has approved such award through the Findings of Fact and Conclusions of Law; OR The basic support obligation, as defined in DRL Sec. 240 (1-b), presumptively results in the correct amount of child support to be awarded, and the amount attributable to the non-custodial parent is $ per ; the amount of child support agreed to in this action deviates from the amount attributable to the non-custodial parent, and the Court has approved of such agreed-upon amount based upon the reasons set forth in the Findings of Fact and Conclusions of Law, which are incorporated herein by reference; OR  This provision is not applicable ; and it is further ORDERED AND ADJUDGED that, if maintenance is to be paid pursuant to this Judgment of Divorce, then, subject to the terms of DRL 240(1-b), upon termination of the maintenance award, the amount of child support payable shall be adjusted , without prejudice to either party’s right to seek a modification pursuant to DRL 236 (B)(9)(2); and it is further 2525 ORDERED AND ADJUDGED that  Plaintiff OR  Defendant shall pay to  Plaintiff OR  Defendant OR  third party, namely: and for reasonable child care expenses pursuant to  written agreement of the parties OR  the court’s decision, the amount of $________ per year or  per week  bi-weekly  semi-monthly  per month . OR  Not applicable ; and it is further 2626 ORDERED AND ADJUDGED 1- that  Plaintiff OR  Defendant shall pay to  Plaintiff OR  Defendant OR  third party, namely: ,OR  through the Support Collection Unit (because a party is currently receiving child support services or an application has been made for such services) as and for non-custodial parent’s pro rata share of future health care expenses not (UD-11 Rev. 1/31/18) -7- covered by insurance,_________% of such expenses pursuant to  written agreement of the parties OR  the court’s decision OR  Not applicable ; 2- Check which box or boxes apply: a)  if the custodial parent provides the health insurance for the children:  Plaintiff OR  Defendant shall pay to  Plaintiff OR Defendant OR  third party, namely: ,OR  through the Support Collection Unit (because a party is currently receiving child support services or an application has been made for such services) as and for  The non-custodial parent’s pro rata share of health insurance premiums for the children , $______ per year or  per week  bi-weekly  semi-monthly  per month OR b)  if the non-custodial parent provides the health insurance for the children: The custodial parent’s pro rata share of health insurance premiums for the children, $________ per year or  per week  bi-weekly  semi-monthly  per month will be deducted from the child support obligation . 3-  Plaintiff OR  Defendant shall apply to the state sponsored health insurance plan for coverage for the unemancipated children of the marriage. The costs shall be allocated pursuant to  written agreement of the parties OR  the court’s decision OR  Not applicable ; and it is further 2727 ORDERED AND ADJUDGED that  Plaintiff OR  Defendant shall pay to Plaintiff OR  Defendant OR  third party, namely: OR  through the Support Collection Unit (because a party is currently receiving child support services or an application has been made for such services) For education or extraordinary expenses of the children $______ per year or  per week  bi-weekly  semi-monthly  per month or ______% of such expenses pursuant to  written agreement of the parties OR  the court’s decision OR  Not applicable ; and it is further 2828 ORDERED AND ADJUDGED that  Plaintiff OR  Defendant is hereby awarded exclusive occupancy of the marital residence located at , together with its contents until further order of the court, OR  as follows: ; OR  Not applicable ; and it is further (UD-11 Rev. 1/31/18) -8- 2929 ORDERED AND ADJUDGED that the Settlement Agreement entered into between the parties on the day of ,  an original OR  a transcript of which is on file with this Court and incorporated herein by reference, shall survive and shall not be merged into this judgment, and the parties are hereby directed to comply with all legally enforceable terms and conditions of said agreement as if such terms and conditions were set forth in their entirety herein; and it is further ORDERED AND ADJUDGED, that the Supreme Court shall retain jurisdiction to hear any applications to enforce the provisions of said Settlement Agreement or to enforce or modify the provisions of this judgment, provided the court retains jurisdiction of the matter concurrently with the Family Court for the purpose of specifically enforcing, such of the provisions of that (separation agreement)(stipulation agreement) as are capable of specific enforcement, to the extent permitted by law, and of modifying such judgment with respect to maintenance, support, custody or visitation to the extent permitted by law , or both; and it is further ORDERED AND ADJUDGED, that any applications brought in Supreme Court to enforce the provisions of said Settlement Agreement or to enforce or modify the provisions of this Judgment shall be brought in a County wherein one of the parties reside; provided that if there are minor children of the marriage, such applications shall be brought in a County wherein one of the parties or the child or children reside, except, in the discretion of the judge, for good cause. Good cause applications shall be made by motion or order to show cause. Where the address of either party and any child or children is unknown and not a matter of public record, or is subject to an existing confidentiality order pursuant to DRL § 254 or FCA § 154-b, such applications may be brought in the County where the Judgment was entered; and it is further (UD-11 Rev. 1/31/18) -9- 3030 ORDERED AND ADJUDGED that a separate Qualified Medical Child Support Order shall be issued simultaneously herewith OR  Not applicable; and it is further 3131 ORDERED AND ADJUDGED that, pursuant to the  parties' Settlement Agreement OR  the court’s decision , a separate Qualified Domestic Relations Order shall be issued simultaneously herewith or as soon as practicable OR  Not applicable ; and it is further 3232 ORDERED AND ADJUDGED that,  pursuant to the Court’s decision OR  pursuant to the parties’ agreement, the Court Court or the Support Collection Unit (where a party is currently receiving child support services or an application has been made for such services) shall issue an income deduction order simultaneously herewith OR  Not applicable because the Court has made a finding in the Findings of Fact and Conclusions of Law that alternative arrangements have been made between the parties, or that good cause exists not to require such an order; and it is further 3333 ORDERED AND ADJUDGED that both parties are authorized to resume the use of any prior surname, and it is further 3434 ORDERED AND ADJUDGED that  Plaintiff OR  Defendant is authorized to resume use of the prior surname ; and it is further 3535 ORDERED AND ADJUDGED that  Plaintiff OR  Defendant is hereby awarded counsel and/or expert’s fees as follows: ___________________________________________________________________________ __________________________________ OR  Not applicable ; and it is further 3636 ORDERED AND ADJUDGED that  Plaintiff OR  Defendant shall be served with a copy of this judgment, with notice of entry, by the  Plaintiff OR  Defendant , within days of such entry. 3737 Dated: ENTER: _________________________ J.S.C./Ref (UD-11 Rev. 1/31/18) -10-