New York > Statewide > Family Court > Uniform Interstate Family Support Act
Uniform Support Petition UIFSA-4 - New York
| Uniform Support Petition Form. This is a New York form and can be used in Uniform Interstate Family Support Act Family Court Statewide . |
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UNIFORM SUPPORT PETITION Petitioner Respondent [ ] IV-D Non Public Assistance [ ] IV-D Non PA Medicaid [ ] Full Services [ ] Medical Services Only [ ] IV-D Public Assistance [ ] IV-E Foster Care (IV-D Case) [ ] Non IV-D File Stamp Responding IV-D Case No. __________________________________ Responding Docket No. _____________________________________ Initiating IV-D Case No. __________________________________ Initiating Docket No. _____________________________________ I. Action The Respondent and/or the Respondent's property is subject to the jurisdiction of the responding tribunal. The Respondent owes a duty of support to the following children: Full Name (First, Middle, Last) Date of Birth Social Security No. The Petitioner files this Petition to request: [ ] Establishment of a Paternity [ ] Establishment of Order for: [ ] Child Support [ ] Medical Coverage [ ] Spousal Support [ ] Reasonable Attorney Fees, Other Fees and Costs To: [ ] Support for a Prior Period; From: [ ] Paternity Testing Costs in the Amount of $ _______________________ [ ] Modification of a Support Order [ ] Other Remedy Sought: II. Grounds Supporting the Remedy Sought in Section I (when applicable) [] [] [] Respondent is the noncustodial parent of the children named in this Petition. A modification is appropriate due to a change in circumstances. Grounds for other remedy sought: Uniform Support Petition OMB 0970 - 0085 Page 1 of 2 2001 © American LegalNet, Inc. UNIFORM SUPPORT PETITION, PAGE 2 III. Additional Supporting Information Initiating IV-D Case No. The following documents are attached to, and incorporated in, this Petition. These documents contain the required additional information. [ ] Petitioner's General Testimony [ ] Acknowledgment of Paternity [ ] Other: [ ] Affidavit in Support of Establishing Paternity [ ] Birth Certificate of the Child IV. Verification [] Under penalties of perjury, all information and facts stated in this Petition are true to the best of my knowledge and belief. _________________________________________________________________________ [ ] Signature of Petitioner [ ] IV-D Representative/Title __________________________ Date _______________________________ Sworn to and Signed Before Me This Date, County/State ___________________________________________________________________ Notary Public, Court/Agency Official and Title ______________________________________ Commission Expires _________________________ Date ________________________________________________________________________ Signature of Petitioner's Attorney / Bar Number (if applicable) Uniform Support Petition Page 2 of 2 2001 © American LegalNet, Inc. INSTRUCTIONS FOR UNIFORM SUPPORT PETITION OMB 0970 - 0085 PURPOSE OF THE FORM: The Uniform Support Petition is a legal pleading needed for the responding State to initiate action. Its purposes are to show how the tribunal has jurisdiction, to show enough facts to notify the respondent of the claim being made, and to provide the petitioner with a means to request specific action or relief. Additional information can be provided in the accompanying affidavits and other attachments. HEADING/CAPTION: # # Identify the Petitioner and Respondent in the appropriate spaces. Check the appropriate space to identify the type of case: IV-D Non Public Assistance; IV-D Non Public Assistance Medicaid (indicate whether receiving Full Services or Medical Services Only); IV-D Public Assistance; IV-E Foster Care; or Non IV-D. IV-D means the case is being worked by the State or local child support enforcement agency (i.e., IV-D agency). Public Assistance means the obligee's family receives IV-A cash payments [IV-A was formerly called Aid to Families with Dependent Children (AFDC) and is now called Temporary Family Assistance]. A IV-D Non Public Assistance Medicaid case is a case where the obligee's family receives Medicaid but does not receive Public Assistance (IV-A cash payments). Under "Responding IV-D Case No." and "Responding Docket No.", enter appropriate case and docket numbers that the responding State uses to identify the case, if applicable and if known. Under "docket number", you may enter the docket number, cause number, or any other appropriate reference number. Under "Initiating IV-D Case No." and "Initiating Docket No.", enter appropriate case and docket numbers which your IV-D agency or local tribunal has assigned to the case. Under "docket number", you may enter the docket number, cause number, or any other appropriate reference number. # # SECTION I, ACTION: List the children on whose behalf the action in the petition is requested. Include each child's full name (First, Middle, Last), date of birth, and Social Security Number. Check the appropriate boxes to indicate which actions are requested. Multiple actions may be requested, as appropriate. # Check "Establishment of Paternity" to request that paternity be established. In a IV-D case, ask another State to establish paternity only if use of long-arm jurisdiction is not appropriate. Be sure to attach an "Affidavit in Support of Establishing Paternity" for each child whose paternity is at issue. Check "Establishment of Order" to request that an order be established. Indicate the type of order by checking the appropriate box. Check "Child Support" to request the initial establishment of a new child support order. If the responding State uses UIFSA and an order governing the same obligor, obligee, and child(ren) already exists, you should generally only request the establishment of a new order if: (1) there is more than one existing order, (2) the obligor, obligee, and child have all moved out of the issuing States, and (3) the parties have not filed written consent allowing an issuing State to assert jurisdiction. # Instructions for Uniform Support Petition--Page 1 2001 © American LegalNet, Inc. Check "Spousal Support" to request establishment of a spousal support order. Do not check this item in a IV-D case; establishment of spousal support is not a IV-D function. When requesting establishment of spousal support, contact the support enforcement agency for the appropriate procedure. Check "Support for a Prior Period" to request establishment of support for a prior period. On the "From" and "To" lines, enter the beginning and ending dates of the prior period. If support for multiple prior time periods is being requested, enter the beginning date of the first period in the "From" line, and enter the closing date of the las
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