Wyoming County, NY

Violation of Support Application

Steps

1. Cover This section is complete This section is incomplete
2. Hearing Questions This section is complete This section is incomplete
3. Family Court and Criminal Court Financial Form This section is complete This section is incomplete
4. Income Worksheet This section is complete This section is incomplete
5. Other Assets: MUST BE COMPLETED This section is complete This section is incomplete

Cover

Wyoming County Public Defender
18 Linwood Avenue
Warsaw, New York 14569
(585) 786-8450
Enclosed please find paperwork that you must complete to apply for the Wyoming County Public Defenders Office. Please return the paperwork, proof of your income, and a copy of your criminal charges, Family Court petition, or Violation of Support petition, whichever is applicable.
Contact the Public Defender's Office 3 days after submitting your application to make sure it was received.
Sincerely,

Public Defender Office
Wyoming County
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Hearing Questions

Wyoming County Public Defender
18 Linwood Avenue
Warsaw, New York 14569
(585) 786-8450
You must fill in all fields. If you do not know the answer or it does not apply to you, enter "I don't know", "None", or "N/A"
Petition
Reminder: This information is listed in your Violation of Support Petition
Current Obligation*
Not paid since:*
Current arrears (not including administrative fees or past judgements)*
Employment
(Previous employment & job search fields will appear if not currently employed)
Do you work now?
1. Yes
2. No
Where do you work?*
When were you hired?*
How many hours per week do you work?*
What do you do with the time you're not working?*
Where did you last work?*
How long were you employed there?*
When did you stop working there?*
Why did you stop working there?*
Have you filed for a downward modification of child support since your employment circumstances have changed?*
1. Yes
2. No
How long have you been out of work?*
How long have you been looking for work?*
How often do you search for jobs?*
How do you search for jobs?*
What type of work are you looking for? Why not anything else?*
What field are your skills in?*
What geographical location are you looking to work within? Why not wider?*
Do you have any interviews currently lined up?*
When was your last interview?*
Have you reapplied to your previous employer when the VOS was filed? Why?*
Transportation
Do you have a drivers license?*
What is the status of your drivers license?*
Do you own a vehicle?*
What do you use it for?*
Do you use anyone else's vehicle(s)?*
What do you use it for?*
How often do you use it?*
How do you get where you need to go? (shopping, medical appts, etc)*
If you found a job, how would you get there?*
Disability
Are you disabled?
What type of disability do you have?*
How long have you had it?*
What caused your disability?*
Have you worked since this disability?*
What types of jobs have you had?*
Please also state the hours at each job
Do you see a doctor for your disability?*
Please state your doctors name and how often you see them.
Are you on medication for your disability?
What do you take?*
How often do you take it?*
What are its side effects? (if any)*
Are there any restrictions imposed by your doctor or your medication?*
Do you receive SSI or SSD?*
Have you applied for SSI or SSD?
1. Yes
2. No
3. Both
When?*
What is the status of your application?*
When did you start receiving it? (date)*
Housing
Where do you live?*
Do you rent or own?*
Are your payments up to date?*
Where do you get your money to pay them?*
If not up to date, how much in arrears are you?*
Are you currently facing eviction or collection?*
Who lives with you?*
How long have you been living like this?*
Is anyone else in the house employed?*
Lifestyle
Do you have a cell phone?*
Who pays the bill?*
Do you have cable TV?*
Who pays the bill?*
Do you smoke?*
Who buys your cigarettes?*
Do you have credit cards?*
Do they carry a balance?*
Are they in collection?*
When was the last time you made a credit card payment, and how much was it?*
What other household bills do you have?*
Are those bills in arrears?*
Who pays them?*
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Family Court and Criminal Court Financial Form

Client*
Court*
Age*
Date of Birth*
No. of Dependants*
Marital Status*
Public Assistance/Medicaid No. (If Applicable)*
Address*
Phone #*
Number of family members in household*
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Income Worksheet

If any of the following answers is zero or none, enter "0" or "none"
Employment Income*
Unemployment Ins.*
Sub Pay (union)*
Social Security Disability (SSD)*
Social Security Insurance (SSI)*
Pension*
Veterans and/or active service benefits*
Public Assistance Benefits*
Child Support Received*
Child Support Paid*
Rental Income Received*
Any Other Income*
TOTAL INCOME*
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Other Assets: MUST BE COMPLETED

If any of the following answers is zero or none, enter "0" or "none"
Savings, Checking, Trust Accounts*
Location of same*
Cash on hand*
Vehicles Owned and their value(s)*
Year, Make, and Model
Amount owed (if any)*
Real Estate and its value*
TOTAL ASSETS*

Leave This Blank:

1. Receive an email copy of this form.
Email address

This field is not part of the form submission.
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Violation of Support Application

Steps

Cover

Hearing Questions

Family Court and Criminal Court Financial Form

Income Worksheet

Other Assets: MUST BE COMPLETED

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