At the Supreme Court, __County, held at the courthouse at __, New York, on the __ day of __, 19 .

PRESENT:

HON. (Justice Supreme Court) ______

TITLE OF ACTION

The issues in this action having been referred to a referee to hear and report, and the referee having submitted his report,

NOW, on motion of __, Esq., attorney for the (plaintiff) (defendant), it is

ORDERED, that the Referee's Report is confirmed; and it is further

(State ground or grounds in the language set forth above); and it is further

(State ground or grounds in the language set forth above); and it is further

Adjudged that the marriage contract heretofore existing between __ plaintiff, and __, defendant, is annulled because of the fraud of the defendant; and it is further

Adjudged that the marriage entered into between __, plaintiff, and __, defendant, on the __ day of __, 19 , is declared null and void because of the prior subsisting marriage of the defendant; and it is further

Adjudged that (plaintiff) (defendant) is awarded custody of the infant issue of the marriage, to wit:

__, born __, 19 __, born __, 19 __, born __, 19 ;

and it is further

Ordered and Adjudged that (plaintiff) (defendant) may have visitation with the __ (number) infant children away from the custodial residence during the following periods:

(a) on Saturday or Sunday of each week between the hours of __ a.m. and __ p.m., provided (defendant) (plaintiff) shall notify (defendant) (plaintiff) not later than Wednesday of each week of the day selected;

(specify holidays);

(specify holidays); and

(d) for a period of __ consecutive calendar weeks during the summer recess from school, beginning on Sunday of the first week selected, provided (defendant)(plaintiff)) shall notify (plaintiff) (defendant) not later than June 10th in each year of the particular weeks selected; and it is further

Ordered and Adjudged that the order made the __ day of __, 19 , by the Family Court of the State of New York, County of __, in the proceeding bearing Docket number is continued, and a copy of this judgment shall be served by plaintiff's attorney upon the Clerk of said Court within 10 days after the date hereof; and it is further

and it is further Adjudged that:

And the Court having found the parties' agreement to deviate from the basic child support obligations is approved for the following reasons: [See D.R.L. § 240(1-b) (f)]

and it is further

Ordered and Adjudged that the defendant shall pay to the plaintiff (third party __) by check or money order drawn to (his) (her) order and forwarded on __ (day) of each week commencing with __ (date), 19 , the first __ (date) after the date of this judgment, to (the plaintiff) (third __ party) at (his) (her) residence or at such other place as (he) (she) may designate in writing, the sum of $ __ per week as maintenance, plus the sum of $ __ per week per child for the support of the children, making a total sum of $ __ per week, which total sum is inclusive of all obligations of defendant for the support and maintenance of plaintiff and the children except extraordinary medical or dental expense

( if plaintiff is awarded exclusive possession of marital premises, add: and extraordinary repairs of marital premises; consider requirement for purchase of insurance policy); and it is further

( Set forth either street address or, if there is no street number, the metes and bounds description.)

until the youngest child is 21, or sooner emancipated, and (plaintiff) (defendant) shall within __ days after service upon (him) (her) of a copy of this judgment with notice of entry remove (himself) (herself) therefrom, and upon proof by affidavit of (plaintiff) (defendant) and (his) (her) attorney of (defendant's) (plaintiff's) failure to remove from said premises within the time herein provided, a writ of assistance shall issue without further notice to (defendant) (plaintiff); and it is further

( include disposition of property upon termination of exclusive possession of real property, if any); and it is further

Ordered and Adjudged that the defendant shall pay to the plaintiff, by check or money order, forwarded to (him) (her) at (his)(her)(residence) (the office of (his)(her) attorney) within __ days after service upon him of a copy of this judgment with notice of entry, as and for counsel fee and expenses, the sum of $ __; and it is further

Ordered and Adjudged that the (separation agreement) (stipulation) entered into between the parties on the __ day of __, 19 , a copy of which is attached to and incorporated in this judgment by reference, shall (not survive and shall be merged) (survive and shall not be merged) in this judgment, and the parties hereby are directed to comply with every legally enforceable term and provision of such (separation agreement) (stipulation) including any provision to submit an appropriate issue to arbitration before a single arbitrator, as if such term or provision were set forth in its entirety herein, and 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) as are capable of specific enforcement, to the extent permitted by law, and of making such further judgment with respect to maintenance, support, custody or visitation as it finds appropriate under the circumstances existing at the time application for that purpose is made to it, or both; and it is further

Ordered and Adjudged that (plaintiff) (defendant) is authorized to resume the use of her maiden name or other former surname, to wit: __; and it is further

Ordered and Adjudged that plaintiff, __, residing at __, recover from __, residing at __, the sum of $ __, as arrears due under the order of this court (Family Court, __ County), dated __, 19 , and that plaintiff have execution therefor.

Signature