Application for Child Support Services

14 Jun, 2017 alaska, Divorce, Legal Forms 0

Application for Child Support.pdf Form allows you to apply for the Child Support Services Division.Download

Extracted Text for Proper Search

CSSD 04-1017 (Rev. 01/03/12) (12 pp.) Custodian’s Application for Services Page 1 of 12

STATE OF ALASKA
DEPARTMENT OF REVENUE
CHILD SUPPORT SERVICES DIVISION

CUSTODIAN’S APPLICATION FOR SERVICES

Custodial parents and other custodians must complete an application for services to obtain Child Support
Services Division (CSSD) services. CSSD can then establish paternity, establish child support and medical
support orders, and enforce or modify existing support orders, even if the non custodial parent lives in another
state. CSSD charges no fees, although the cost of determining paternity may be charged to the father. CSSD
collects and distributes payments from non custodial parents; we do not provide the child support funds. When
child support is established by CSSD in an administrative order, the amount is calculated based on the Alaska
Supreme Court child support rule, Civil Rule 90.3.

The application and the “Statement of Support Received” must be completed and signed separately. Additional
information about the application, your responsibilities, CSSD services, and public assistance is found on the
next three pages of this application packet. If an existing order from a court, from CSSD, or from another child
support agency mentions child support, custody, visitation, or parental rights, include it with your application.

If you or your children have been victims of domestic violence, you may ask that your location be kept
confidential by completing the “Affidavit and Request for Address Confidentiality” on page 11.

After you have submitted your application, your case will be set up within 20 days. It may take 60 days or more
to make progress toward establishing or enforcing an order. During that time, contact us if you have additional
information or important questions. Our automated KIDSLINE provides answers to common questions and
allows you to access payment information and leave messages for caseworkers. Also, you may visit one of our
offices or go to our web page at www.childsupport.alaska.gov
for more information. Please let us know if you
need assistance or other accommodations to use our services.

KIDSLINE: (907) 269-6900 KIDSLINE Toll Free (in Alaska): 1-800-478-3300
TDD machine: (907) 269-6894 TDD machine Toll Free (in Alaska): 1-800-370-6894

Statewide – Main Office Fairbanks Mat-Su
550 W 7
th Ave Suite 310 675 7 th Ave Station J2 845 W Commercial Dr
Anchorage AK 99501-6699 Fairbanks AK 99701-4531 Wasilla AK 99654-6937
(907) 269-6900 (907) 451-2830 (907) 357-3550

Southeast Mailing address for payments
240 Main Street, First Floor CSSD
PO Box 110402 PO Box 100380
Juneau AK 9981-0402 Anchorage AK 99510-0380
(907) 465-5887

CSSD 04-1017 (Rev. 01/03/12) (12 pp.) Custodian’s Application for Services Page 2 of 12

STATE OF ALASKA
DEPARTMENT OF REVENUE
CHILD SUPPORT SERVICES DIVISION

INFORMATION ABOUT CHILD SUPPORT SERVICES

Child Support Services
You are required to provide your social security number to CSSD. This is mandatory under federal law at 42
USC Section 405 (c)(2)(C). Your social security number will be used by CSSD to identify and locate you for
the purposes of establishing paternity and establishing, modifying and enforcing support obligations. You will
be asked for your social security number when you call CSSD so we can identify your case. We may also ask
for your social security number on forms you may need to complete in order for CSSD to help you.

CSSD provides child support services for parents or third-party custodians. CSSD can:

 collect and distribute child support payments;
 establish paternity;
 establish child support and medical support orders;
 enforce child support orders, even if the paying parent is not in Alaska;
 modify support orders if there is good reason;
 require banks, employers, the Permanent Fund, and others to withhold the paying parent’s income or assets;
 attach IRS tax refunds to collect child support; and
 provide interstate services when parents move to other states.
 enforce medical support orders.

There is no fee for these services, although the costs of determining paternity may be charged to the father.
CSSD cannot monitor or modify visitation or custody orders; a court must address those matters.

Child Support Payments
Support orders established by CSSD begin with the month CSSD receives the application, unless the children
received public assistance earlier. Once CSSD receives an application, all support payments must be made
through CSSD unless a court order provides otherwise. If a custodian receives a direct payment before the case
is set up, the custodian must tell CSSD, in writing, how much was received and when. Money collected by
CSSD is paid to the custodian, unless the custodian or the child is receiving or has received public assistance.
In those cases, the state debt must be repaid.

Establishing Paternity
If paternity has not been established and child support is requested, CSSD will establish paternity. This
generally occurs when a child is born to unmarried parents. If the child was born in Alaska, parents can contact
the Bureau of Vital Statistics to complete an affidavit if they agree about paternity. If the child was born in
another state, they must contact that state for assistance. If they disagree, CSSD will require genetic tests to
determine paternity. The man who proves to be the biological father may be required to pay for genetic tests and
related costs.

CSSD 04-1017 (Rev. 01/03/12) (12 pp.) Custodian’s Application for Services Page 3 of 12

Establishing Support Orders
CSSD calculates child support using the Child Support Guidelines in Alaska Supreme Court Rule of Civil
Procedure 90.3. This rule requires that the child support obligation be a percentage of the adjusted annual
income of the non custodial parent based on the number of children in the support order. Parties can ask for
exceptions. If a parent does not provide income information, CSSD will use the best information available to
determine the parent’s income from all sources.

We use an “Administrative Child Support Order” when we issue a child support or medical support order.
Either party can appeal the findings in that order and present evidence. After an administrative review, we may
change those findings. Either party may appeal the CSSD decision to the Office of Administrative Hearings
Administrative Law Judge. Either party may then appeal the Administrative Law Judge’s decision to the
superior court.

Enforcing Support Orders
If child support is owed and CSSD identifies the non custodial parent’s employer, bank account, or other
financial account, we normally issue an Order to Withhold and Deliver those wages or assets. The withholding
order is a standard method of ensuring timely support payments. Support is withheld directly from the payroll
office or the bank account. Non custodial parents who want to make additional payments, or who are self-
employed, may pay by check or money order. Please include the case number with the payment, and send it to
the payment mailing address (see the cover sheet of this application). Cash payments can be made only in
person, and only in Anchorage.

Failure to pay support may result in collection actions including liens, judgments, withholding from Permanent
Fund Dividends, wages, or other income, credit bureau reporting, the seizure of bank and financial accounts,
and other civil and criminal law actions. Non custodial parents who owe more than four months of child
support may lose their occupational licenses or their driver’s licenses. Non custodial parents who owe $2,500
or more in past child support (arrears) risk losing their passports. We file liens on real estate if arrears are at
least $2,500 or equal to one year’s support. CSSD may take the non custodial parent’s federal income tax
refunds to pay arrears. If the custodian received public assistance in Alaska, the IRS refund is applied first to
reimburse the state. IRS funds remaining after the state is paid go to the custodian.

Modifying Support Orders
Either party, or the state, has the right to request a review of a child support order. Both parties must provide
financial information to CSSD. Private agreements between parties are not valid unless approved by the court.
Situations that could result in support modification are:

 a child listed in the order has reached the age of majority or been legally emancipated;
 the child support guidelines were adopted or significantly amended after the support order was issued;
 the obligor’s income has changed to the extent that support would change by 15 percent; or
 medical support or post-majority support language is needed in the order.

If a court issues a support order, usually the court must modify the order. If CSSD or another child support
agency issues an administrative support order, the agency can modify it.

Your Rights and Responsibilities
Alaska law allows interest to be charged on payments received ten or more days past the due date, on
judgments, and on most arrears.

If you use CSSD services, you must notify us immediately of the following:
 address changes, new employment, or changes in earnings;
 permanent custody changes;

CSSD 04-1017 (Rev. 01/03/12) (12 pp.) Custodian’s Application for Services Page 4 of 12

 visitation when there is a court order for visitation;
 payments received directly from the non custodial parent;
 availability of or changes in health care coverage for the children;
 any action by the parties that may affect support (such as seeking a new or modified court order, custody
changes, adoptions, bankruptcy, or other collections).

We invite parties to attend and participate in case proceedings and hearings to protect their interests. An
Assistant Attorney General represents CSSD in child support hearings; parties may hire attorneys at their own
expense.

Medical Support
Federal and state laws require parents to provide medical support for their minor children. CSSD will provide
medical support services to the applicant. Those services will include establishment, modification and
enforcement of support orders that include health insurance provisions and cash medical support, in addition to
regular child support. Credit for health care coverage may raise or lower the amount of ongoing child support,
depending on which parent provides the coverage. Health insurance benefits available through the Indian
Health Service or the military may satisfy the medical support requirement. Custodians who receive only
Medicaid must assign to the state their medical insurance benefits or any fixed amounts of cash medical support
the non-custodial parent is ordered to pay.

Public Assistance
If the custodian receives public assistance through ATAP (the Alaska Temporary Assistance Program, which
replaced AFDC), through another state’s welfare program (such as those funded through TANF, the federal
Temporary Aid for Needy Families program) or through Medicaid or Denali KidCare, we automatically provide
services without requiring a CSSD application. In ATAP or TANF cases, child support must be assigned to the
state. This means the state will keep the child support received up to the amount of public assistance paid out.
Enforcement cannot stop while public assistance is being received, while the children are in licensed foster care,
or if the other party applies for services. If the custodian receives only Medicaid or Denali KidCare and does
not want cash support, CSSD must be notified. We will continue to enforce only the medical support order. If
all public assistance ends, CSSD services will stop upon the custodian’s written request, although enforcement
to recover money owed to the state may continue.

Requesting Confidentiality
The Child Support Services Division may be required to release information about you or your children to other
parties or agencies. Information that may be released may include names, addresses, social security numbers,
and birth dates. This information will be released only when authorized by law and only as needed to take
action on your case. This information will not be released to the general public. However, if your case is filed
in court, information in the court case may be available to the public.

If you or your children have been victims of domestic violence, including harassment, threats, mental or
emotional abuse, physical violence including sexual assault or incest, and parental kidnapping, you may
ask that information about your address and location be kept confidential.

You must complete the “Affidavit and Request for Address Confidentiality” on page 11, sign it before a notary
or a witness, and return it within 30 days. Attach any documents you have (such as police reports, protective
orders, restraining orders, or medical records) to show why you believe the release of information about your
address or your location would threaten your well being. We will review your request and get back to you in
writing. Please contact us if you have questions. The CSSD addresses and phone numbers are on the cover
sheet of this application.

CSSD 04-1017 (Rev. 01/03/12) (12 pp.) Custodian’s Application for Services Page 5 of 12

APPLICATION FOR CHILD SUPPORT SERVICES

Please indicate which services you want. You must provide all information necessary for these services. Attach
complete copies of orders or documents relating to custody, support and paternity. DO NOT SEND ORIGINALS.

Support order establishment Paternity establishment Medical support order establishment

Enforcement of an existing order Review, modification, and enforcement of an existing order

Full name__________________________________ Birth/previous/other names _______________________________
Date of Birth _______________ Birthplace ________________________________ SSN ________________________
Mailing address _____________________________________City____________________ State ____ Zip __________
Home address _______________________________________ City____________________ State ____ Zip __________
Driver’s license state and # _________________Home phone ________________Email address ___________________
Employer____________________________________Work phone _________________ Work hours _______________

Does an attorney represent you in any matters related to the child or the other parent? Yes No If yes, provide
the attorney’s name, address, and phone
__________________________________________________________
Have you ever received public assistance such as ATAP (Alaska Temporary Assistance), TANF (Temporary Aid to
Needy Families), AFDC, or Medicaid?
Yes No If yes, indicate what type, when, in what state, and provide a case
number if available _________________________________________________________________________________

Child’s full name Sex Date and place of birth SSN Who does this child live with?

You are the
mother father relative __________ legal custodian by court order (explain)__________________

Full name ______________________________________ Birth/previous/other names ___________________________
Date of Birth _________________ Birthplace ________________________________ SSN _______________________
Address
Current Last known _________________________________________________________________
City_________________________ State _____ Zip __________ Driver’s license state and # ______________________
Home phone _________________ Email _________________ Citizen of
U.S. other country ________________

For office use only: Requested: ___________ Sent: ___________ Case #: ___________________________ Date Date Reinstatement/Existing/Other
INFORMATION ABOUT YOU (THE APPLICANT) PLEASE PRINT
CHILDREN YOU ARE SEEKING SUPPORT FOR (add pages if necessary)
NONCUSTODIAL PARENT YOU ARE SEEKING SUPPORT FROM

CSSD 04-1017 (Rev. 01/03/12) (12 pp.) Custodian’s Application for Services Page 6 of 12

How is the person related to the child? __________________________________________________________________
Height ______Weight _____ Hair color _____Eye color ______ Race__________ Marks, scars, tattoos____________
Does/did the person live or work in Alaska?
Yes No If yes, where and when? _____________________________
Does the person have relatives in Alaska? Who and where? _________________________________________________
Usual occupation __________________________ Union member? (name and local number) ______________________

Current or most recent employer(s) Employer address Employer phone Dates of employment

Military Service:
None Active Reserve Guard Retired
Branch/unit ______________________ Last rank/grade _______________ Yrs in service __________
Tribal or Alaska Native corporation member?
Yes No If yes, which corporation? _________________________
Does this person have an attorney regarding child support?
No Yes Who? ______________________________
Does or did the person receive (or does the person expect future) cash gifts, settlements, or awards? _________________
_________________________________________________________________________________________________
Other information that may be helpful in obtaining support (for example, bank accounts, stocks, property, pension, or
other sources of income) ____________________________________________________________________________

Divorced Date of separation _____________________ Date of divorce _________________
Court case number ________________________________
City/County/State__________________________________
Attach a complete copy of the divorce decree/order.

Married but separated Marriage date/place ___________________ Separation date ___________________

Divorce/Dissolution pending Date filed _____________________ Separation date _______________________
City/County/State_____________________ Court case number_________________

Never married Separation date (if parents lived together) _________________________________
Complete the following. Attach a birth certificate for each child.

Child: _____________ Did the father sign an Affidavit of Paternity?
Yes No
Is the father’s name on the birth certificate?
Yes No*
In what state was the birth certificate issued? _______________
Child: _____________ Did the father sign an Affidavit of Paternity?
Yes No
Is the father’s name on the birth certificate?
Yes No*
In what state was the birth certificate issued? _______________
Child: _____________ Did the father sign an Affidavit of Paternity?
Yes No
Is the father’s name on the birth certificate?
Yes No*
In what state was the birth certificate issued? _______________

*If no, complete page 12
Other (explain) __________________________________________________________________________________
RELATIONSHIP BETWEEN THE PARENTS

CSSD 04-1017 (Rev. 01/03/12) (12 pp.) Custodian’s Application for Services Page 7 of 12

Check here if you have been a victim of domestic violence and you want your address to be kept confidential from the
other party. Please submit an “Affidavit and Request for Address Confidentiality” (see page 11).

Check here if you agree that if CSSD sends a child support payment to you in error, you want to repay the
overpayment gradually out of future child support payments (instead of immediately in a lump sum). CSSD will
provide child support services to you even if you don’t agree to repay overpayments from future payments.

Check here if you have or have had a child support case in Alaska or another state, and explain: For which child?
________________ In what state/county? ______________ Do you know the case number? ___________________

Check here if the child is eligible for Indian Health Service, military, or other health care coverage, and explain: Which
child? ______________________ Eligibility through which parent? ______________________________________
Type of coverage? ______________________________________________________________________________

Include a complete copy of all orders relating to custody, support, and paternity.
Do not send original documents.
Complete the Statement of Support Received even if you receive no support.
Complete the confidentiality affidavit if you want your address withheld from the other party.

Your signature is required before CSSD can process this case.

Applicant's signature: ________________________________________ Date: _____________________

Return the completed application, the statement of support received, the confidentiality affidavit (if needed) and all
supporting documents to:

Child Support Services Division
550 W 7
th Avenue Suite 310
Anchorage AK 99501-6699

OTHER INFORMATION

CSSD 04-1017 (Rev. 01/03/12) (12 pp.) Custodian’s Application for Services Page 8 of 12

Instructions for Completing the Statement of Support Received

1. Enter your name and the non custodial parent’s name. Include the CSSD case number if you have a case already.

2. Enter the full name and date of birth for each child in your custody.

3. If there is an administrative support order from Alaska or another state, check the first option. If there is a court
order, check the second option, and indicate whether the court order includes child support, alimony (spousal
support), or both. If there is both a court order and an administrative order, check both the first and second
options. If there is no order of any kind, check the third option.

4. If you have received child support from the non custodial parent, check the first option and complete the “Child
Support” column in the table on the bottom of the page. Don’t forget to indicate the year(s). See example below.
If you have received some child support, but you are not sure when or how much, check the second option and
enter your estimates in the table (marked “estimates”) or on a separate page. If you have received no child support
at any time, check the third option.

NOTE: If the custodial parent or the child is receiving government benefits from Social Security, the Veterans
Administration, or another government agency, and the benefits are based on the non custodial parent’s disability
or retirement, these benefits may be credited toward the non custodial parent’s support obligation. Please provide
information about such benefits on a separate page.

5. If you have received alimony or spousal support from the non custodial parent, check the first option and complete
the “Alimony/Spousal” column in the table. Don’t forget to indicate the year(s). See example below. If you have
received some spousal support, but you are not sure when or how much, check the second option and enter your
estimates in the table (marked “estimates”) or on a separate page. If you have received no alimony or spousal
support at any time, check the third option.

6. If a child support order is already in effect, and you lived with the other parent or the other parent had custody of
the child at any time since the child support order took effect, please check the “Yes” box and attach a written
explanation

Table: Enter only the support you have received in this table. Do not enter support owed. Start your entries with the
first month and year you were supposed to receive support, and continue through the current month and year. Enter
“0” in months when support was due but no support was received. Add additional pages, if necessary.

For example, if the child support order says you should have received $250 child support per month beginning in June
of 2000, and no spousal support, and the custodial parent paid irregularly and never paid the full monthly child support
amount, your “support received” table might look like this in December 2001:

Year
2000 Child
Support Alimony/
Spousal Year
2001 Child
Support Alimony/
Spousal
Jan N/A N/A Jan $0 N/A
Feb Feb $75
Ma r Mar $50
A pr Apr $0
Ma y May $0
Jun $100 Jun $75
Jul 0 Jul $175
Au g $150 Aug 0
Se p $150 Sep 0
Oct 0 Oct $200
Nov $225 Nov $100
Dec $175 Dec $0

1606 (CSSD 04-1017 Rev. 04/27/10) (12 pp.) Custodian’s Application for Services Page 9 of 12

STATEMENT OF SUPPORT RECEIVED

See previous page for instructions. If you received no support, please check “no support received” and sign the next page.

1. Your name: ______________________ CSSD case # __________Non custodial parent’s name ______________________

2. You are the custodian of these minor children:

Child’s full name Date of birth Child’s full name Date of birth

Check the appropriate boxes in items 3-6, and complete the table below (or submit separate estimates, as necessary).

3.
An administrative order from
CSSD or another child support
agency directs that you are
entitled to receive child support.
OR
A court order directs that you are
entitled to receive

child support

alimony (spousal support)
OR
No administrative or court
order for child support is in
effect at this time.

4. List in the table below the
child support payments you have
received directly from the non
custodial parent. Don’t forget to
indicate the year.
OR If you aren’t sure how much
child support you’ve received from
the non custodial parent, list your
best estimate by month and year in
the table below (or on a separate
page)

OR
You have received no
child support from the non
custodial parent.

5.
List in the table below the
alimony (spousal support) you
have received directly from the
non custodial parent. Don’t
forget to indicate the year.
OR

If you aren’t sure how much
alimony (spousal support) you’ve
received from the non custodial
parent, list your best estimate by
month and year in the table below
(or on a separate page)
OR You have received no
alimony (spousal support)
from the non custodial
parent.

6. If a child support order is already in effect, did you live with the other parent (or has the other parent had custody of the
children) at any time since that order was issued?
Yes No If your answer is “Yes,” attach a description of the time
periods when you lived together (or when the other parent had custody) since the child support order was issued.

Enter only support received in the following table. Do not enter support due.
Year: Child Support
Alimony/
S
pousal
Year: Child Support Alimony/
S pousal
Year: Child Support Alimony/
S pousal
Jan
Jan Jan
Feb Feb Feb
Mar Mar Mar
Apr Apr Apr
May May May
Jun Jun Jun
July July July
Aug Aug Aug
Sep Sep Sep
Oct Oct Oct
Nov Nov Nov
Dec Dec Dec

(Continued on the next page, where your signature is required.)

1606 (CSSD 04-1017 Rev. 04/27/10) (12 pp.) Custodian’s Application for Services Page 10 of 12

Statement of Support Received continued

Year: Child Support
Alimony/
S
pousal

Year: Child Support Alimony/
S
pousal

Year: Child Support Alimony/
S
pousal
Jan
Jan Jan
Feb Feb Feb
Mar Mar Mar
Apr Apr Apr
May May May
Jun Jun Jun
July July July
Aug Aug Aug
Sep Sep Sep
Oct Oct Oct
Nov Nov Nov
Dec Dec Dec

Year: Child Support
Alimony/
S
pousal

Year: Child Support Alimony/
S
pousal

Year: Child Support Alimony/
S
pousal
Jan
Jan Jan
Feb Feb Feb
Mar Mar Mar
Apr Apr Apr
May May May
Jun Jun Jun
July July July
Aug Aug Aug
Sep Sep Sep
Oct Oct Oct
Nov Nov Nov
Dec Dec Dec

Year: Child Support
Alimony/
S
pousal

Year: Child Support Alimony/
S
pousal

Year: Child Support Alimony/
S
pousal
Jan
Jan Jan
Feb Feb Feb
Mar Mar Mar
Apr Apr Apr
May May May
Jun Jun Jun
July July July
Aug Aug Aug
Sep Sep Sep
Oct Oct Oct
Nov Nov Nov
Dec Dec Dec

Signature
__________________________________ Date ____________________

0502 (CSSD 04-1017 Rev. 04/27/10) (12 pp.) Custodian’s Application for Services Page 11 of 12
Affidavit and Request for Nondisclosure of Identifying Information

Complete this affidavit only if you want your address and information about your location to be kept confidential and not
released to a person (such as a parent or custodian) who would otherwise be entitled to have the information. CSSD
will respond in writing with a decision about your request for confidentiality.

I, ______________________________________________, swear under penalty of perjury that the following information
is true to the best of my knowledge and belief:

Name of person I do not want information released to: __________________________
Person’s relationship to me or the child: __________________
CSSD case number: _____________

Please check all that apply:

1. This person has committed domestic violence (threatened, harassed, physically or mentally abused, or committed
sexual assault or incest) against me or my child.

2. A domestic restraining or violence protective order has been issued against the person.

3. The person has been charged with a crime (such as assault or harassment) or been involved in a criminal civil or
criminal court case in which I was a party, a victim, a witness, or otherwise involved.

If you checked any of the above please explain what happened, when, where and who was involved.
____________________________________________________________________________________________________________
____________________________________________________________________________________________________________

If you checked # 2 or 3, please indicate the Court location and case number:_______________________

If you did not check any of the boxes above, please explain why you feel threatened by this person.
____________________________________________________________________________________________________________
____________________________________________________________________________________________________________
____________________________________________________________________________________________________________

If you need additional space for your answers, please use the back of this page.

Signature ______________________________ Date__________________________

SUBSCRIBED and SWORN to before me this _________ day of _______________________, 20 ______

___________________________________________
Notary Public for the State of ______________
My commission expires ___________________

If you can’t get to a notary, please sign before a witness and have the witness complete the information below.

I know the person who signed this form is the person he or she claims to be, and I witnessed the signature above.

Witness signature _______________________________ Witness name (please print) __________________________________
Witness address _______________________________________________Witness phone ________________________________

CSSD MAILING ADDRESS: 550 W 7 th AVE SUITE 310 ANCHORAGE AK 99501-6699

1604D (CSSD 04-1017 Rev. 04/27/10) (12 pp.) Custodian’s Application for Services Page 12 of 12

PATERNITY WITNESS STATEMENT

CSSD Case No: __________________________

A separate statement is required for each child whose paternity must be established
(use the back of the form for detailed explanations)

I, ____________________, am the natural mother of (child’s name - first, middle, last) ___________________________________

Child’s date of birth __________
Male Female Child’s place of birth (city, county, state) ________________________

a. Date of conception (month, date, year) ______________ City, county, state where conception occurred: ___________________

b. Full term pregnancy?
Yes No If no, explain: ___________________________________________________________

c. The child was conceived as a result of sexual intercourse between ______________________and me during the time stated above.

d. A man is named as the father on the child’s birth certificate.
Yes (attach copy) No If yes, provide his name and address:
_______________________________________________________________________________________________________

e. I was married at the time of this child’s birth.
Yes No If yes, complete the following:

Husband’s name (first, middle, last) and last known address: ________________________________________________
_________________________________________________________________________________________________

State why husband is not the father of this child and attach all appropriate documents, including divorce decree, test results,
and prior findings of non paternity, if any: ________________________________________________________________
_________________________________________________________________________________________________

f. Genetic tests were completed to determine the father of the child.
Yes No If yes, attach results, explain outcome, and
list name(s) and address(es) of the man or men tested: ___________________________________________________________
_______________________________________________________________________________________________________

g. I had sexual intercourse with another man or men (other than the man I am naming as the child’s natural father) during the time
30 days before or 30 days after the child was conceived
Yes No If yes, complete the following:

Name and address of other man/men: ___________________________________________________________________

The other man/men are biologically related to the man I am naming as the child’s natural father.
Yes No If yes,
state the biological relationship (e.g., brother, cousin, uncle, etc.) _______________________________________________

I do not believe the other man/men is/are the father because ____________________________________________________
____________________________________________________________________________________________________

All the information and facts contained in this Paternity Witness Statement are true and correct to the best of my knowledge
and belief. I agree to submit myself and my child, if I am the custodian, to genetic testing when necessary to establish
paternity.

Signature of mother _____________________________________ Date ____________________

Statement of witness to mother’s signature

I willingly state that I know _________________________, who signed this form, and I witnessed her signature above.
Signature of witness __________________________________ Date _________________________________________
Printed name of witness ________________________________ Telephone number of witness _______________________
Address of witness _______________________________________________________________________________________

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If parents cannot agree on custody and visitation, they're also able to ask the court to appoint a mental wellness expert like a psychologist to perform a custody evaluation. They can be assured that an urgent message will be delivered once you get access to your phone. They often get defensive while speaking about their child's food habits. They should take into account their children's age, personality and experiences.

The program gives educational material on the significance of healthful diet, staying physically active, and the way to plan your financial plan for the entire month. Clearly, you may always have a look at government programs for temporary help too. You may take a look at government assistance programs in your town for aid.

Should you need help paying for Christmas, here's a massive collection of charities that will help you. People around us can require help at any instance of the day. If this is so, you might be able to register for help from these types of groups. There's even additional aid for energy costs known as the heating and cooling bills.

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