COURT COUNTY OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .ODHS 7076 (Rev. 7/90):::::::Index No.Calendar No.JUDICIAL SUBPOENAPlaintiff(s) -against-Defendant(s)DR-6CASE NO.APPLICATION FOR CHILD SUPPORT SERVICES NON-PUBLIC ASSISTANCE APPLICANT/RECIPIENTI the undersigned, request Child Support Services from the County Child Support Enforcement Agency. I understand and agree to the following conditions:1.I am a resident of the County in which services are requested.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .2.Recipients of child support services shall cooperate to the best of their ability with the CSEA. (See attached rights and responsibility information).THE PEOPLE OF THE STATE OF NEW YORK TOThe Child Support Enforcement Agency can assist you in providing the following services:1.Location of Absent Parents.The agency can assist in finding where an absent parent is currently living, in what city, town or state. The applicant can request Location Services Only , if the sole need in to find the whereabouts of the absent parent.GREETINGS:WE COMMAND YOU, that all business and excuses being laid aside, you and each of you attend before Court at the the Honorable,2.Establishment or Modification of Child Support and Medical Support.located at County ofo'clock in the day of, on the, 20, at or adjourned date, to testify and give evidence as a witness in this action on the part of thenoon, and at any recessed in roomThe CSEA can assist you to obtain an order for support if you are separated, have been deserted or need to establish paternity (fatherhood). The CSEA can also assist you in changing the amount of support orders (modification), and to obtain medical support.Your failure to comply with this subpoena is punishable as a contempt of court and will make you liable to the party on whose behalf this subpoena was issued for a maximum penalty of $50 and all damages sustained as a result of your failure to comply.3.Enforcement of Existing Orders.4.Federal and State Income Tax Refund Offset Submittals for the Collection of Child Support Arrearages., one of the Justices of theCourt in Witness, Honorableday of, 20 County,5.Withholding of Wages and Unearned Income for the Payment of Court Ordered Support.The agency can help you get payroll deductions for current and back child support and can intercept unemployment compensation to collect child support.(Attorney must sign above and type name below)Attorney(s) for6.Establishment of Paternity.The agency can obtain a court order for the establishment paternity (fatherhood), if you were not married to the father of the child.Office and P.O. Address7.Collection and Disbursement of Payments. The CSEA can collect the child support for you, and send you a check for the amount of the payments received. Back Support collected will be paid to you until all of the back support you are owed is paid. If you received ADC in the past and support was assigned to the state, back support collected will be paid to theTelephone No.: Facsimile No.: E-Mail Address:Mobile Tel. No.:American LegalNet, Inc. www.USCourtForms.comstate after you receive back support owed to you.8.Interstate Collection of Child Support.The agency can assist you in collecting support if the payor is living in another state or in some foreign countries.3.The only fee you can be charged for services is a one dollar application fee. Some counties pay this fee for the applicants. 4.If you use a private attorney to help you collect child support on your case you are responsible for any attorneyfees. The CSEA will provide you an attorney free of charge to work on you case, if one is needed.APPLICANT INFORMATION (INFORMATION ABOUT YOU)COURT COUNTY OFNameDate of Birth. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .:::::::Index No.Social Security Number (SSN)Current Marital Status (Check One)Calendar No.[] Single [] Married [] Divorced [] Separated [] Deserted [] WidowedJUDICIAL SUBPOENAPlaintiff(s)Type(s) of Service(s) Requested: All services listed Location of absent parent onlyOther (please explain) -against-(Do Not Write In This Space)FOR AGENCY USE ONLYCase NameDate Mailed/Picked UpDefendant(s)Case NumberDate Returned or File Date. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Applicants Name (Last, First, Middle)Telephone Number (Home)THE PEOPLE OF THE STATE OF NEW YORK TOAddress ( Street/ Route, P.O. Box)(Work)City, State and Zip CodeGREETINGS:INFORMATION ON CHILDRENWE COMMAND YOU, that all business and excuses being laid aside, you and each of you attend before Court at the the Honorable,1Child 3Child 2located at CountyChildof, on the, at or adjourned date, to testify and give evidence as a witness in this action on the part of the, 20noon, and at any recessed in roomo'clock in the day ofa.. Nameb. SexYour failure to comply with this subpoena is punishable as a contempt of court and will make you liable to the party on whose behalf this subpoena was issued for a maximum penalty of $50 and all damages sustained as a result of your failure to comply.c. SSNd. Date of Birth (DOB)e. Name(s) of Absent Parent, one of the Justices of the, 20 County,day ofCourt in Witness, Honorablef. Has Paternity (fatherhood) Been Established?(Attorney must sign above and type name below)g. Is There A Court Order For Support?(Yes or No)Attorney(s) forABSENT PARENT INFORMATION OR PARENT ORDERED TO PAY CHILD SUPPORTAbsent Parent #3Absent Parent #2Absent Parent #1Office and P.O. AddressNameAddress, City, State, Zip CodeTelephone No.: Facsimile No.: E-Mail Address:SSNDate of Birth (DOB)Mobile Tel. No.:American LegalNet, Inc. www.USCourtForms.comCOURT COUNTY OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Name of Employer:::::::Index No.Address of Employer City, State, Zip Code) Amount of Support Ordered (Wk, Bi-Wk, Mo) Case Number of Support OrderCalendar No.JUDICIAL SUBPOENAPlaintiff(s)-against-Date of Support OrderDefendant(s). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .THE PEOPLE OF THE STATE OF NEW YORK ParentTOCourt Where Order Was Issued (City, County, State) Military Service Give Date and Branch Entered Arrest Record: Give Date and Place
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