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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
Next: Missouri Notice of Hearing Form Previous: Missouri Petition For The Dissolution of Marriage Form
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