Form 4-11 Petition for Modification of Support

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Form 4-11 Support Modification Petition

Form 4-11 Petition for Modification of an Order of Support

Step 1 of 9

Case Information

County Name Docket Number Petitioner Name Respondent Name Support Order Made By

1. Petitioner / Agency / Respondent Information

Petitioner Type Relationship to Child or Children Petitioner Residence Address Assignee Agency Place of Business Respondent Residence Address

2. Prior Court Action

Petitioner Role in Prior Action Prior Court Type Prior Action County Other Court Name Action Name Index / Docket Number Respondent Role in Prior Action

3. Existing Judgment or Order

Existing Document Type Date of Existing Judgment or Order Person Directed Under Existing Judgment or Order Terms of Existing Judgment or Order Attached Copy Type Support Order Date Person Directed Under Support Order Support Order Terms Attached Support Copy Type

4. Children Affected by the Order

Child 1 Name Child 1 Address Child 1 Date of Birth Child 2 Name Child 2 Address Child 2 Date of Birth Child 3 Name Child 3 Address Child 3 Date of Birth Child 4 Name Child 4 Address Child 4 Date of Birth

5. Jurisdiction Information

Jurisdiction Document Type Court Without Exclusive Jurisdiction Other Court Name Modification Document Type Other Court is outside New York State

6. Basis for Modification

Entry Document Type Substantial change of circumstances Substantial Change Explanation Three years have passed Income changed by fifteen percent or more Income Change Basis Document Type to Be Modified Requested Modification Reason for Not Applying Earlier

7. Child Support Services and Previous Applications

Child Support Services Selection Wherefore Court Type Wherefore Document Type Wherefore Other Court Name Wherefore Date

8. Signature Section

Dated Upload Signature Image Print or Type Name Attorney Signature, if any Attorney Name Attorney Address Line 1 Attorney Address Line 2

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