Application For Services Of Child Support Services Division
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1APPLICATION FOR SERVICES
OF CHILD SUPPORT SERVICES DIVISION
Notice to Court Clerk
If this application is filed with the court, send the application
along with a copy of the child support order to CSSD.
Court Case No.
I voluntarily apply for the services of the Child Support Services Division (CSSD). I understand
that CSSD will take all action necessary to enforce the child support order for the child(ren)
named below. I consent to CSSD's enforcement of the medical support order. I understand
that either party may ask CSSD to review the amount of the child support order and propose
changes to the court. I also understand that I will be required to provide information necessary
to enforce the support obligation.
My Name
Mailing Address
(box or street number)
(city)
(state)
(ZIP)
Telephone Number. Home
Work
Other Parent's Name
Mailing Address
(box or street number)
(city)
(state)
(ZIP)
Telephone Number. Home
Work
I am the
Mother
Father
Legal Custodian
Non-Parent Custodian of
the child(ren) whose name(s) and date(s) of birth are:
DOB
DOB
DOB
DOB
DOB
DOB
A child support order is currently in effect:
Date of child support order:
Court case number:
Court location (city and state):
Names of parents when child support was ordered:
Date
Applicant's Signature
* AS 25.27.265(b) requires parties to child support proceedings to inform CSSD of their social
security numbers and other specified information. Your social security number may be used
to insure compliance with the child support order. You must provide your social security
number on form DR-314. The information on DR-314 will be held confidential.
DR-315 (10/06)(cs);
CSSD 04-1017c
AS 25.27.100 and .103
APPLICATION FOR SERVICES OF CHILD SUPPORT SERVICES DIVISION
Civil R. 90.1(f)(1)
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