Florida > Workers Comp
Request For Amount Of Unpaid Support Owed - Florida
| Request For Amount Of Unpaid Support Owed Form. This is a Florida form and can be used in Workers Comp . |
|
||||||
 Get this form for FREE as a print-only pdf |
|||||||
|
Request for Amount of Unpaid Support Owed To: Florida Office of Judges of Compensation Claims From: ____________________________________ ___________________ (Bar Number) I am requesting a written response as to the amount of unpaid child support the following individual owes, for the purposes of a workers' compensation claims settlement. This information will be used solely for that purpose and will not be otherwise disseminated or disclosed. I understand that the Clerk of Court is the official record keeper for child support and that workers' compensation settlements require obtaining similar information from the Clerks of Court. Rule 60Q6.123. OJC Case Number: Claimant Name: Address ________________________________________ ________________________________________ __________________________________ __________________________________ SS Number ___________________________ Date of Birth _____/______/_______ (mm/dd/yyyy) ____/____/_________ Response to Request No record found Claimant owes $_____________ in unpaid support according to the Florida Department of Revenue. American LegalNet, Inc. www.FormsWorkFlow.com
|
|||||||
