Notice Of Determination Of Controlling Order
ADVERTISEMENT
1
2
3
4NOTICE OF DETERMINATION OF CONTROLLING ORDER
The information on this form may be disclosed as authorized by law.
If you are not the intended recipient, you are hereby notified that any use, disclosure, distribution,
or copying of this form or its contents is strictly prohibited.
Date of Notice:
IV-D Case:
[ ]
TANF
[ ]
IV-E Foster Care
Legal n
Medicaid Only
Obligor:
ame
[ ]
(first, middle, last, suffix)
[ ]
Former Assistance
Never Assistance
File Stamp
[ ]
Obligee: Legal name
Non-IV-D Case:
[ ]
(first, middle, last, suffix)
To:
Responding Locator Code: ___________
State ______________
(Agency Name and Address)
Responding IV-D Case Identifier: __________________________________
Responding Tribunal Number: __________________________________
From:
Initiating Locator Code: ___________
State ______________
(Agency Name and Address)
Initiating IV-D Case Identifier: __________________________________
Initiating Tribunal Number: __________________________________
NOTE:
[ ] This form sent through EDE
1.
On _____________
________________________________________________
,
(tribunal name, county, state)
(date)
determined which order to recognize for prospective enforcement. The following orders were considered:
#
County
State
Date of Order
IV-D Case Identifier
Tribunal Number
Order Type
1
2
3
2.
Check which option applies:
[ ] The tribunal determined that order number __________________
listed above is the controlling order for
(enter number)
prospective support.
[ ] The tribunal determined that none of the existing orders is the controlling order for prospective support.
A new controlling order was entered; a certified copy is attached.
3.
Because it issued the controlling order, the law of _______________
governs the duration of the support obligation.
(state)
4.
$ ____________________ per
__________________________
is the current support amount.
(frequency)
5.
The tribunal reconciled arrears and calculated them to be $ _____________________ as of _________________
(date).
A certified copy of the order reconciling arrears is attached.
Expiration Date: 12/31/2019
Notice of Determination of Controlling Order
OMB 0970 – 0085
Page 1 of 2
ADVERTISEMENT
0 votes
Related Articles
Related forms
Related Categories
Parent category: Legal