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im

FAMILY COtJRT OF THE STATE OF NEW YORK


COUNTY OF KINGS
INDEX NO.
F-28901-08/10/A/B/C
HenaSvenson,
Petitioner,
JUDICIAL NOTICE TO
THE COURT
V.

Michael Krichevsky,
Respondent.

Co

Notice to the court under the authority ofthe constitutions ofthe United States and the C0-<

New York; authority ofthe United States Supreme Court and Demand for this OTurt||Si2f=

follow the Supreme Law ofthe Land. -


C8 S

1. Michael Krichevsky,Pro Se,(KRICHEVSKY)by special appearanceUNDERDURESS


and wthout submitting to thejurisdiction ofthis court her^y puts this court onjudicial notice to
cease and desist any further unlawful assault against him.
2 KRICHEVSKY hereby challenges thejurisdiction ofJohn Fasone and hereby puts him
onjudicial notice that the U.S. Supreme Court has clearly estabUshed that oncejurisdiction has
been challenged, it is presumed that the court lacksjurisdiction unless or until the evidentiary
sufficiency is provided and submitted to the record.
3. The presumption is that a court lacksjurisdiction on a particular issue until it has been
.ltimiaiic&m over the snWect matter adsts. The 6cts showing the adstence of
jurisdiction must be affirmatively in the record.
4. Ifjurisdiction is challenged,the burden is on the party claiming jurisdiction to
demonstrate tint the court hasjuriscBction over the subject matter. The Umits uponjurisdiction
^RECEIVED ^
FAMILY COURT OF THE YORK
COUNTY OF KINGSI3 JUL i 9 AH lO^ 28
ELENA SVENSON, DOCKET NO.
Petitioner, F-28901-08/10/A/B/C
-against-

MICHAEL KRICHEVSKY, ORDER TO SHOW


Respondent. CAUSE TO HOLD IN
CONTEMPT

Hon. Jeanette Ruiz

Upon the annexed affidavit ofMICHAEL KRICHEVSKY,sworn to the 18 day of April, 2013,
and upon all the pleadings annexed hereto.

LET the petitioner, show cause before this Court at the Courthouse located at 330 Jay
Street, Brooklyn, New York, on the day of , 2013, at 9:30 o'clock in the
forenoon ofthat day, why an order should not be made and entered:
1. adjudging the Petitioner in contempt of this Court for perjuring herself under oath
during child support proceedings started from 2008;
2. adjudging the Petitioner in contempt ofthis Court for maliciously prosecuting in
this court false Petition to punish Michael Krichevsky for contempt ofcourt based on
John Fasone's void order and without probable cause causing Michael Krichevsky to

suffer stroke;

3. adjudging the Petitioner in contempt ofthis Court for deliberate concealment of


her job and income during child support and contempt proceedings.
4. referring this matter to district attorney for criminal prosecution.
5. declaring that support order against respondent dated February 3, 2010 by
magistrate John Fasone ofKings County Family Court is VOID on the grounds that it
was obtained by Petitioner's actual fraud, fraud upon the court, perjury, attorney's
lynco A-^uw.-i A

FAMILY COURT OF THE STATE OF NEW YORK


COUNTY OF KINGS QdAi303H
ELENA SVENSON, DOCKET NO.
Petitioner, F-28901-08/10/A/B/C
-against-

MICHAEL KRICHEVSKY, NOTICE OF MOTION


Respondent. TO HOLD m
CONTEMPT

Hon. Jeanette Ruiz

COUNSELORS:

PLEASE TAKE NOTICE,that upon the annexed petition ofMichael Krichevsky, swom to the
18 day ofJuly, 2013, and upon all the pleadings and proceedings heretofore had herein, the
undersigned will move this Court at Part 27, thereof^ to be held at the Courthouse located at 330
Jay Street, Brooklyn, New York on the 18th day ofJuly, 2013 at 9:30 a.m. in the forenoon ofthat
day or as soon thereafter as counsel can be heard:
For an order by the Court:
1. adjudging the Petitioner in contempt ofthis Court for peijuring herself under oath;
2. adjudging the Petitioner in contempt ofthis Court for maliciously prosecuting in
this court false Petition to punish Michael Krichevsky in contempt ofcourt based on
John Fasone's void order and without probable cause causing Michael Krichevsky to
suffer stroke;

3. referring this matter to district attorney for criminal prosecution.


4. declaring that support order against respondent dated February 3, 2010 by
magistrate John Fasone ofKings County Family Court is VOID on the groimds that it
was obtained by Petitioner's actual fraud, fraud upon the court, perjury, attorney's
misconduct, misrepresentation, witness-tempering, obstruction ofjustice and in
absence ofdue process pursuant to CPLR 2002, R5015(a)(3),(4), R5012, and 5019
(a).
GF15 8/2010
At a term ofthe Family Court of the
State of New York, held in and for
the County of Kings, at 330 Jay
Street, Brooklyn, NY 11201, on July
19,2013

PRESENT: John M. Fasone, Support Magistrate


In the Matter ofa Support Proceeding File#: 142040
Docket#: F-28901-08/1 OA
Michael Krichevsky, SSN; XXX-XX-7181,
Petitioner, CSMS #: NV05003T1
- against -
- -eRBERrONMeTfONS
Elena Svenson, SSN: XXX-XX-8546, (#03 on Supplemental
Respondent. "A" and #04 on
Supplemental"B &C")

A motion having been filed with this Court on July 19, 2013, requesting an order on a(n)
OTSC - to hold in contempt and a Support Magistrate of this Court upon examining the motion
papers and supporting affidavit(s)and hearing testimony in relation thereto and Michael Krichevsky
only having appeared pro finds that findings ofcontempt are clearly beyond the limited statutory
authority of a family court support magistrate. See. Family Court Act 439-e.

The Court notes that if respondent-father truly believes that petitioner-mother has either
perjured herselfduring any ofthe hearings on any ofthe petitions filed under this docket,or that she
has perpetrated any fraud upon this Court, such claims/allegations are more properly addressed to
the Office ofthe Kings County District Attomey, and it is therefore

ORDERED that the motion of Michael Krichevsky is denied.

SPECIFIC WRITTEN OBJECTIONS TO THIS ORDER MAY BE FILED WITH


THIS COURT WITHIN 30 DAYS OF THE DATE THE ORDER WAS RECEIVED
IN COURT OR BYPERSONAL SERVICE,OR IF THE ORDER WAS RECEIVED
BY MAIL, WITHIN 35 DAYS OF THE MAILING OF THE ORDER.

Dated: July 19,2013 ENTER

>

asone, Support Magistrate

Check applicable box:


Order mailed on [specify date(s) and to whom mailed]:
Order received in court on [specify date(s) and to whom given]:_
Kings County Family Court
330 Jay Street
Brooklyn, NY 11201
CtllJ itlA;-:.
i( ;
O'U)aS!K!!lli' n'l :'. .
lVlAli.(;PrtJM/l; (H'l'i : ! 1 .n.
\
/
11SS4S 102.3 C017 ,)|.HM|.|ili.ij.n.i.i|),iiii|..|"HJjIii'.||i|"|i!l"Ii
FAMILY COURT OF THE STATE OF NEW YORK
COUNTY OF KINGS

Docket No.F28901-08
Elena Svenson,
Plaintiff,
OBJECTION AND ,
-against- AFFXDAVrriN S
SUPPORT ^
Michael Krichevsky, a
ro c'!-
Defendant cr> -

ai

STATE OF NEW YORK ss.:


COUNTY OF KINGS

Michael Krichevsky(KRICHEVSKY),Pro Se, Sui Juris respectfully avers upon

his firsthand knowledge under penalties of pequry:

1. That I am the defendant in error in the within action.

2. The fects stated in this affidavit are within my personal knowledge,and if called on as a

wimess,I could competently testify thereto.

3. I incorporate by reference herein my motion to take judicial notice per CPLR,which I filed in
this court together with Motion to Hold in Contempt,exhibit A.This motion was personally
served on petitioner Svenson together with motion to hold her in contempt on July 18,2013 and
she did not object More than a month has passed and this motion neither granted, nor denied.
Mr.Fasone did not schedule a hearing on this motion if he needed. However,he proceeded to
TWfllfft decisions and issuing orders(exhibit B)without taking this mandatory judicial notice

on the record. As such,1 presume that my Motion to Take Judicial Notice ignored and object to
misconduct and long-standing, continuous, unconstitutional pattem of denial ofdue
process.I take exception and object to Mr.Fasone's scheduled coercive hearing on September
RECaVED

0C 15 2014
S'^pej^ial Term,Part ,ofthe Family Court ofthe StateofNew
York, held in and for the County of Kings,at the Courthouse,330
Jay Street,Brooklyn, New Yoik on the day of ,

PRESENT; Hon.
Judge

Docket NO.F-2890|-08/13F

Elena Svenson,
Plaintiff,

-against-
EMMERGENCY ORDER
TO SHOW CAUSE
Michael ICrichevsky, estate.
Falsely accused, victim.

Upon the annexed affidavit of Michael Krichevsky,Pro Se,swom under duress to on the
13"'' day ofDecember,2014,and on all the proceedings had herein,
LET the Plaintiffor Plaintiff attorneys, show cause before me or one ofthe Judges ofthis
Court atthe Courthouse located at 1 ^Livingston Street, Brooklyn, New York,at a Special Term,
Part thereof,on thej(^iy of at 9:30 o'clock in the forenoon ofthat day,or
as soon thereafter as counsel can be heard,
WHY an order should not be made and entered:
a) pursuant to Rules 5015(a),4404(b),4405 and 4406 ofthe Civil Practice Law
and Rules setting aside the Court's order herein, or modifj'ing the Court's order
herein, or setting a new trial in the interests ofjustice, on the ground that the
order is VOID due to lostjuri^ction,fraud upon the court, pequry,contrary to
the weight ofthe evidence,and for such other and further relief as to this Court
may seem just and proper
b) sanctioning Plaintiffor her attorney per rule 130-1.1 for vexatious litigation.
ORDER^,that oral argument is not required on the return date hereof
SUFFICIENT REASON APPEARING THEREFOR,let personal service ofa copy ofthis
Order to Show Cause,together with a copy ofthe papers upon which it was granted, upon the
Plaintiffor Plaintiff attorneys on or before the day of ,be deemed good and
sufficient service.

ENTER

J.C.C.
FAMILY COURT OF THE STATE OF NEW YORK
COUNTY OF KINGS

INDEXNO.F.28901-08/13
Elena Svenson,
Plaintiff, perjurer Administrative Judge
Edwina
-against- Richardson-Mendelson

Michael Krichevsky,
Falsely accused, victim.

STATE OF NEW YORK


COUNTY OF KINGS

Nelli Frid, being duly swonr,says:

I am not a party to the action: I reside at Brooklyn, New York,and I am over 18 years of
age.

On November 10,2014,1 served the within OBJECTION TO MAGISTRATE MILSAP'S


FINAL ORDER - EXTORTION,HARASSMENT AND TORTURE;COMPLAINT FOR
ADMINISTRATIVE REVIEW;AFFIDAVIT OF PROTEST AND DISCLAMER by depositing a
true copy thereof,enclosed in a post-paid wrapper,in an oflScial depository under the exclusive
care and custody ofthe United States Postal Service within New York State, addressed to the
following at the last known address set forth below:

ELENA SVENSON
2620 OCEAN PKWY,APT 3K
BROOKLYN.NY 11235

Nelli Frid

Swom to before me
on November II,2014
MIRAZYBINA
Notaiy Public State of New York
No.012V6246221

Mum.
NOTARY PUBL|l^
Qualified in Richmond County
My Commlselen awiree August8.20/>
FAMILY COURT OF THE STATE OF NEW YORK ^ fefe/ '
COUNTY OF KINGS 2HI'. ^

Elena Svenson, INDEXNO.r 03/


Plaintiff, perjurer <T
Administrative Judge '
Edwina
-against- Richardsoa-Mendelson
Michael Krichevsky,
Falsely accused, victim.

NOTICE TO AGENT IS NOTICE TO PRINCIPAL

OBJECTION TO MAGISTRATE MILSAP'S FINAL ORDER - EXTORTION


HARASSMENT AND TORTURE;COMPLAINT FOR ADMINISTRATIVE REVIEW-
AFFIDAVIT OF PROTEST AND DISCLAMER
STATE OF NEW YORK)
COUNTY OF KINGS )ss.:
Michael Knchevsky, Sui Juris, self-govemed man under protest and duress, by special
appearance in denial ofjurisdiction ofthis Private for-proflt corporate entity named Family Comt
says:

1 I, Michael Knchevsky, have firsthand knowledge ofthe following facts and could
competently testify thereto, except as to those matters, which I stated upon information and belief
and certifies that this document is not frivolous per 130-1.1.
2. I reserve my all God-given, inalienable rights together with privileges and immunities
guaranteed to me by the Law ofNations, Constitution of United States ofAmerica,the State of
New York and its treaties, including Family Court Act.
I am informed that by admitting that I am Defendant or Respondent in this action I would
submit to thejunsdiction ofthis court, and tlierefore I claim the status ofthe Victim and Falsely
Accused in the within action. I am over the age ofeighteen.
FAMILY COURT OF THE STATE OF NEW YORK
CITY OF NEW YORK
KINGS COUNTY
330 Jay Street
Brooklyn, New York 11201

HON.JEANETTE RUIZ Natasha McDougall,Esq.


Supervising Judge Michele Rubin,Esq.
Court Attorneys to Judge Rtr.-
Mr. Michael Krichevsky
4221 Atlantic Avenue
Brooklyn, NY 11224

June 24, 2014


Re: Docket # F-28901/08

Dear Mr. Krichevsky,


Your letters to the Hon. Edwina Richardson-Mendekon, Adininistrative Judge of New^Ycf^City Family Cour-
and to the Hon.Jeanette Ruiz,Supervising Judge of Kings County Family Court,have been forwarded to n".!.
for a reply as a Judge may not read or respond to exparie communicadons.
I apologize for the delay in responding to your letters; my notes indicated that your letters had already been
answered.

In your letters you complain about the manner in which your case was handled by Support Magistrate Jonr.
Fasone and you request the court's intervention. Although Judge Ruiz is Supervising Judge she is ethically
prohibited from interfering with proceedings before another Judge,Support Magistrate or Referee.
.\dditionally. please note that Family Court is a court of record and all requests for relief must be properly filed
and served pursuant to the Family Court Act and the Civil Practice Law and Rules. The court cannot entertain
any application submitted by letter.
If you disagree with the final decision of the Support Magistrate, your recourse is the filing <.r :
within the statutorj' time frame. Objections are decided by a Family Court Judge. If you di^.iu'.i
decision of the Family CourtJudge, your recourse is to file an appeal in the Appellate Division, becnrr
Department. If the time frame within which to file an objection or appeal has elapsed, you
your concerns with an attorney, who would be in the best position to explain Family Court proccti;.-
advise you of your rights, explain what,if any,remedies may be available to you,and make any approp; ..
motions and applications on your behalf. If you cannot afford to hire an attorney, die Faii^y Court Voiuntcc:
Attorney Program may be able to assist you or Legal Information for Families Today(LlFi)can provide you
helpful information. Both programs have locations in the Kings County Family Court courthouse. Y'ou uv
seek their assistance without an appointment. The clerk's ofGce or the self-represented unit can pr
with the current operating hours of both programs.
Support Magistrates are subject to review every year and your complaint about the manner in which your ca-t
was handled bv Support Magistrate Fasone wiU be considered as part of that review.
The Family Court is dedicated to sen-ing the many litigants who appear here with the utmost digniti* and
efficiency.
yciy truly yours, ,

Court Attorney to Hon.Jeanette Rui:


Superitising Judge,Kings Co;;:::
F.C.A-413-1,424-a; Art 5-B Fonn4-17
DRL 236-B,240 (FinancialDisclosure
912m
Affidavit)
FAMILY COURT OF THE STATE OF NEW YORK
COUNTY OF KINGS

In the Matter ofa Proceeding for Si5>p9rt


Docket No.:F-28901-08

ELENA SVENSON,

Petitioner, FINANCIAL
DISCLOSURE
-against- AFFIDAVIT
PRE-FATHER
MICHAEL KRICHEVSKY, ABANDONMENT
Respondent

NOTICE:YOU ARE REQUIRED TO ATTACH TO THIS FORM A CURRENT AND


REPRESENTATIVE PAYCHECK STUB AND COPIES OF YOUR MOST RECENTLY FILED
STATE AND FEDERALINCOME TAX RETURNS,INCLUDING A COPY OF THE W-2 WAGE
AND TAX STATEMENTCS)SUBMITTED WITH THE RETURNS. YOUMAYALSOBE
REQUIRED TO PRODUCE OTHERPAYCHECK STUBS,EMPLOYMENT OR BUSINESS
RECORDS AND PROOF OF CLAIMED EXPENSES. YOU ARE ALSO REQUIRED TO PROVIDE
INFORMATION RELATING TO ALL ACCIDENT,LIFE AND HEALTHINSURANCE PLANS
AVAILABLETO YOU FOR THEPROVISION OFINSURANCE,HEALTH CARE,DENTAL
CARE,OPTICAL CARE,PRESCRIPTION DRUG AND OTHERPHARMACEUTICAL AND
HEALTH-RELATED BENEFITS FDR THE CHILD(REN)FOR WHOM SUPPORT IS SOUGHT.

STATE OF NEW YORK )


):ss.:
COUNTY OF KINGS )

FT JRNA SVENSON,the PetitiOTier hBin,residing at 2620 Ocean Paricwav. Apartment 3-K.Brooklyn. New
York 11235/lying duly sworn,deposes and says diat die following is an accurate statemait of my income
from all sources, my liabilities, my assets and my net worth,from whatever sources, and whatever kind and
nature, and wherever situated:
nvCOMEFRQM SOURCES:The correct amount ofdie child support obligation is presumed to be
a percentage ofincome as d^ed by law. The percentages are setforth in Addendum A.Other pertinent
informatian is set forth in Addenda B and C.List your income from all sources as follows:
a, wap arui Raiarifts(as repcntable on Federal and State income tax returns):
1.Employer and address. PLAINTIFF'S
2.Number of members in household. EXHIBIT
3. Number of dq)endents

'Unless oideied confidential, puisoant to Family Court Act lS4<-b, because ofa risk that disclosure would
place die heaUfa,saibty or liberty ofdie party at risk. See Form(3^21 and GF-21a,available at wwwjiycouits.gov.
Form 4-17 Page 2

4. Hours worked per week_


5. Weekly gross salary/wages
6. Weekly deductions:
a. Social Secuiily(PICA)Tax,
b. New York State Tax
c. Federal Tax,
d. Odier payroll deductions.
7. Income ofother members ofhousehold
tjqte; attach informationfor additionalemployers on separate pages.
Ij gAif,F.inplnvmentIncome(Describe andlistself-employmentincome;attachtothisformthe mostrecentlyfiled
Federal and State income tax returns,including all schedules):

c. Tnterest/Di^dend Income:

d. Other Income:
1. Workers Con^nsation.
2. Disability Benefits
3. Unemployment Insurance Benefits
4. Social Security Benefits
5. Veterans Benefits
6. Pensions and Retirement Benefits.
7.Fellowships/Stipends/Annuities
e frnTTi nthfT sninces;(List here and explain any other income including but notlimited to: non-income
producing assets; employment 'perics' and reimbursed e35>enses; fiinge benefits as a result of employment;
periodic income,personal injury settlements; non-reported income;and money,goods and services provided by
relatives and friends')

n ASSETS:The Courtcan considerthe assets offire custodial parent and/or tiie non-custodial parentin its award
of child sup^rt.List your assets as follows:
a. Savings account btdance(Name ofbank: _____ a)$
b. nhwiHrig account balance 0Jame of bank: ) b)$
c. Automobile(s)(Year and n^e: ) c)$
Loan infmmation
d. Residence owned(Address:25-80 Ocean Pkwv.#2-M.Brooklvn. NY 11235^ d)$
e. Other real estate nwnerf 120 Qceana Drive West#5D.Brooklvn.NY 11235 e)$
f. Other assets(For exan^le: stocks, bonds,tndlers, boat,etc.) f) $_
g. Driver's,professional, recreational, sporting and otiier licenses and permits held (provide name of issuing
agency,license number and attach a copy if possible)
NOTE:attach TO THIS FORM ANY INFORMATION AS TO ANY ADDITTONAL ASSETS.
Form 4-17 Page 3

jjj nTrraTfrnnvs imOM yvcOME: The Court allows certain deductions from income prior to applying
the child stqtport pKntages. List the deductions that^ly to you as Mows:
a)$_
a. Unieimbursed raqtloyee business expenses b)$_
b. Maintenaice actually paid to ^use not a party to this action* c)$_
c. Maintenance actually paid to ^use who is a party to tba action d)$.
d.tTbiid support actually paid on behalfofnon- subject duld(ien)* e)$
e. Family Assistance
f)$_
f. Supplemental Security Income
g. NYC/Yonkers Income Tax g)$.
h)$,
*Attadx to this form a copy ofthe appropriate Court Order
PENSES. Cmr.D CARE.
IVj
TC'yPRNSFJS^EDUCATTONAL..r^. V" ^ SURANt ;As

partofthe ^biiH siqiport obligation,parents shall be directedto provide health insurance coverage,pay a pro-rated
Lire ofthe cost or premiums to obtain or maintain the health insurance coverage,and pay a pro-rated share of
unreimbursed health- related expenses,pay a pro-rated share ofchUd care expenses and in the Court's discretion
pay ediratjnnal expenses. The Court may direct you to purchase and maintain life and/or accident insurance
benefits or assign benefits on existing poUcies for die benefit of your children. List your information as foUows
and cross out ot delete inapplicable provisions:

a.D I have health insurance coverage through [specify]: enployer or organization private purchase
New York State "Child Health Hus" program New York State Medical Assistance Program.
XI do not have health insurance coverage [If this box is checked, skip to IIV b].
1 My coverage medical Ddental, prescr^tion drug, Doptical, Dother health care services or
benefits [specify]: v i
2 The portion of the cost of the insurance paid by my employer or through my enployment is $
* per [specify time period]: The cost of the insurance paid by me is $
per [specify time piod]: ^
3. The person(s) covered by my insurance is/are:. .
4 My poliCT number is *
5. Coverage does does not presently include my child(ren). The additional cost to me to
include my child(ren) would be [specify cost for each type of benefiU if benefit unavailable,
so indicate]:
Medical: $ pa
Doital:
UCUiai* $.
^
per.- Prescrfytion drugs: $_ .per.

Other Health Services or Benefits [specify]. $. -per.


6. The tiamp. and address of my primary (and secondary) health insurer is/are
7. My primary (and secondary) health plan administrator is/are: (indicate name, address and telephone
number of contact person for employer or organization):

8 There ate npipWipai, dental, D joescription drug, O optical, other healdi care benefits [specify]:
insurance benefits avaMle to the child(ien) throu^ an
Form 4-17 Page 4

individual who is not a party to this action. This individual is [indicate name and relationship]:
.These benefits cost as follows:
per [specify time period]:
b. My child care provider is; The average number of
hours of child care incurred per week are:
c. My child's education^ needs and e;qaises are:
d. I have the following life and accident insurance polides:
1. T tfp. inciifflnce!(Name ofinsurer);
(Beneficiary/Beneficiaries):.

(Name of insurer): $-
(Beneficiaiy/Beneficiaiies):

2. Arridp"^ insnranee: (Name ofinsurer):.


(Name of insurer):.

This infonnatioii is current as of(specify date) .


VT- VARIANCE FROM Tin? PT<Hf!lCNTAGES: The Family Court Act allows the Court to order support
different from the percentages ifthe Courtfinds that the si^rt based upon the percentages would be unjust
or inappropriate due to certain factors. The factors are setfoA in AHdftTirinm n Thefollowing is/are the
factor(s)that the Court should consider in this case:
VI. FYPF.NSFSi In ordering sr^jport by the pacaatages die Court is not obligated to consider expenses.
However,ifthe Coujt varies fim the percentages,expenses may be considered. List your expenses as
follows:[List all expenses on a weekly or monthly basis; however, you must be consistent: if any items are
paid monthly,divide by 4to obtain the weekly payment;if any items are paid weekly, multiply by 4to obtain
the monthly payment).
(Please specify)]:I am listing my expenses on a(weeklyX monthly)basis:
a. Rent or mortgage payment a)$ 2,600
b. Mortgage interest and amortization o)$
c. Realty taxes(if not included in mortgage payment) c)$
d.Insurance on realty ^
e. Utilities: gas electric/ water 120 telephone 200 cable _200. e)$ 520
f. Apartment maintenance 5635.
g. Household repairs(specify:^
h.Food n)>_joug
i. Charge accounts,loans,etc. I) $
(firom Sectioii VII below) 2),
3)___
j. Auto expenses: gas $200 maintenance _msurance &fees ._2.8.8_Ioan 770 j)$ 1,2S8_
k.Public transportation Sfi-
1. Life insurance
m. Health insurance IQQQ
n. Clothing; self$ 500 Son S250 (explain: ) n)$ 250
0.Laundry and dry cleaning o)$ 200
p.Education and tuition /ftYpiain; Privafe School - $650. Math Tutor - $300: Rnplish Tutor - $350: Sport
Form 4-17 Page 5

Titfisnm- 180.
->plS 1.480
ISO
q. Child caie
r)$
r.Contiibutiom
s. Medical Expenses:Dental and Optical r s)$. 200
t)$_ 300
t Entertainment- Movies,conqwter games,X-Box,Play-^^on,Lego u)$. 400
u. Miscellaneous personal exMSsea^^wify: ) v)$. 2,250
V. Other(specify: Vii'ratifms.^cltV,)RiestaiiTaiits, ConcCTts^j
T T AUTT riTRS- TXIANS AND DEBTS:In ordering support by the percentages the Court is not
iZg^tVc^si^^ However.iftheCourtvariesftom the percentages,they may
be considraed. List your liabilities,loans and debts as follows:
Creditor, Creditor.
Creditor^
IHitpose. Purpose.
Purpose
Date incurred. Date incurred. Date incurred.
Total balance due. Total balance due. Total balance due.

NOTE:ATTACH TO THIS FORM INFORMATION REGARDING ANY ADDITIONAL DEBTS.


I have caiduUy

(Petitioner)

Print QpT^^ame
''Sipiatnre of Attorney, if
YQNATANS.LEVr
Attorney's Name (Print or Type)
Law Office of Yonatan S. Levoritz. P.C.
rrmAy Tfilanil g<vynd Floor
BiooklvD. New York 1172S
71R.942-40Q4
Attorney's Address and Trie^one Number

Sworn to before me this ^


day of August. 2009.

Notary Public VDCrOflKATKALOV


NotaiyPiASe. Stats ot New York
NO.01KA614162S
QuaHedbiKkigs County
OocnnilMionBqaasftb.27.2oir