FOR ATTORNEYS
Attached to this web site you will find the required "blue form" (Form 273 A) needed to set up a child support case. The "blue form" and a court order are needed to establish a new case or modify an existing child support order. Please fill out the "blue form" completely and mail, or hand deliver it with your court order to the address above. Your first child support payment and your first year's annual fee are due at the time of setting up your account.
PLEASE COMPLETE THE REVERSE SIDE OF THE FORM ALSO (Form 273 A (7/89)
DALLAS COUNTY CHILD SUPPORT OFFICE
George L. Allen Courts Building- 1st Floor
600 Commerce Street
Dallas, Texas 75202-4602
Please type or Print Legibly
CAUSE IDENTIFICATION INFORMATION
PERSON PAYING SUPPORT
PERSON RECEIVING SUPPORT
COMPLETE ONLY IF WAGE WITHHOLDING ISSUED
PAYMENT INFORMATION
Names of Children (Computer will place in birth date order )
LAST NAME - FIRST NAME - MIDDLE NAME - DATE OF BIRTH - SOCIAL SECURITY NO.
Attorney for Payor/Non-custodial Parent: _________________________________
Name Phone Bar # _________________________________
Attorney for Recipient/Custodial Parent: _________________________________
Name Phone Bar # _________________________________
SUPPLY THIS INFORMATION FORM ON THE DAY OF THE HEARING TO THE CLERK OF THE COURT.
The Child Support Office must have the information on this form 5 days before the first payment is due.
Submitted by: Phone Date Completed _________________________________
Caution: Be sure this case does not involve the Guardian Ad Litem or Friend of the Court programs.
Please verify that final court orders and employer wage withholding orders indicate the same designated office through which child support payments are to be made.
C:\doc\blueform.frm
CHANGE OF ADDRESS FORM
Name of person ordered to pay child support to you
_________________________________
Your S.S.N.
_________________________________
Your Acct. No. _________________________________
Your name _________________________________
Your new address _________________________________
Apt. No. _________________________________
Your City State Zip _________________________________
In "Care Of"_________________________________
Fill in only C/O if you reside with someone with a different last name, including your parents or relatives. The Postal Service may not leave support payments if your name is not listed as a resident, or is not on the mail box.
Your home phone
_________________________________
Your work phone_________________________________
**do not leave this form if correct account number is not entered**
Your signature
Date
(3/98) D I N:\doc\changadd.frm
AFFIDAVIT OF LOST, STOLEN OR NON-RECEIPT OF PAYMENT(S) RECEIVED AND FORWARDED BY DALLAS COUNTY CHILD SUPPORT (D.C.C.S.)
PAYOR ACCT. NO._________________________________
PAYOR'S _________________________________
ADDRESS _________________________________
CITY ST ZIP _________________________________
LOST _________________________________
STOLEN, PC,ER _________________________________
NON- DATE SC,GV BATCH/ CHECK/M.O. INTERNAL
RECEIPT POSTED MO,CC AMOUNT SEQ NO. NUMBER USE ONLY
======= ======= ====== ======== ======= ========== =========
COMPLETE IF
EMPLOYER'S CHECK: _________________________________
NAME/EMPLOYER _________________________________
ADDRESS _________________________________
CITY ST ZIP _________________________________
I hereby certify that the above referenced payment(s) has/have not been negotiated by myself or by any person(s) known to me. I understand that the person, firm or agency that issued the above payments(s) must be notified by D.C.C.S. , and that D.C.C.S. has no control over the time required by said person, firm or agency to issue or obtain replacement(s).
I agree to notify D.C.C.S if I receive, find or recover any payment that I have requested a replacement thereof AND futher agree to not cash or deposit said payment unless and until I am authorized to do so by D.C.C.S.
I hereby acknowledge that I have read the above paragraphs, understanding their implications, and acknowledge receipt of a copy of this form.
Date Signed _________________________________
Address _________________________________
City ST ZIP _________________________________
S.S.N. _________________________________
Home Phone Work Phone _________________________________
C:\doc\lostpymt.frm Oct 23, 1998
| To: Dallas County District Court Administration Alternative Dispute Resolution Program |