Montana Notice and Acknowledgment to Child Support Enforcement Division Form
In the case of a divorce case that has minor children involved being filed in the State of Montana, the Montana Notice and Acknowledgment to Child Support Enforcement Division Form has to be completed and submitted in order to inform Child Support Departments in the state of that divorce.
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Notice to CSED, Page 1 of 2 Approved by the Montana Supreme Court Commission on Self-Represented Litigants and Montana Legal Services Association, 7/24/02 _______________________________ Name _____________________________________ Address _____________________________________ City State Zip Code _____________________________________ Phone Number PETITIONER PRO SE MONTANA _______________ JUDICIAL DISTRICT COURT _____________________ COUNTY In re the Marriage of: ________________________, Petitioner, and ________________________, Respondent.Cause No.: _________________ Notice and Acknowledgment to Child Support Enforcement Division COMES NOW, the Petitioner, _____________________, and gives notice to the State of Montana, Department of Public Health and Human Services, Child Support Enforcement Division, in accordance with M.C.A. § 40-5-202(5), that s/he has filed a Petition for Dissolution of Marriage in the above-entitled action, and that one of the issues in this legal action is child support. A copy of the Petition is attached hereto. In accordance with M.R.Civ.P. 4D(2)(h), the Petitioner also gives notice to the Attorney General of the State of Montana. DATED this ______ day of ____________________, 20___. ____________________________________ Petitioner Pro Se ____________________________________ Print Name Notice to CSED, Page 2 of 2 Approved by the Montana Supreme Court Commission on Self-Represented Litigants and Montana Legal Services Association, 7/24/02 CERTIFICATE OF SERVICE I hereby certify that a copy of the foregoing Notice and Petition for Dissolution were served upo n t he fo llo w ing by mailing t rue and co rrect co pies o n t he ____ day of ________________, 20____, postage prepaid and addressed as follows: Department of Public Health and Human Services Attorney General Child Support Enforcement Division 215 N. Sanders, Third Floor P.O. Box 201401 Helena, Montana 59620-1401 DATED this ______ day of ____________________, 20___. ____________________________________ Petitioner Pro Se ACKNOWLEDGMENT OF SERVICE OF NOTICE I, the undersigned, hereby acknowledge that I received a copy of the Petitioner’s Notice to Child Support Enforcement Division and a copy of the Petition in the above-entitled action. DATED this _____ day of __________________________, 20___. By: _________________________________ DECLINATION BY DEPARTMENT OF PUBLIC HEALTH AND HUMAN SERVICES The Department of Public Health and Human Services declines to enter this proceeding as a party. DATED this _____ day of ____________________________, 20_____. By: DPHHS, Child Support Enforcement Division
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