Alaska > Statewide > Child Support Services Division
Child Support Services Verification Form 04-0950 - Alaska
| Child Support Services Verification Form Form. This is a Alaska form and can be used in Child Support Services Division Statewide . |
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CHILD SUPPORT SERVICES VERIFICATION FORM TO: Phone: FAX: I, CSSD (907) 269-6900 option 3 (907) 787-3310 Type or Print Name of person FROM: Phone: FAX: grant you permission social security number to disclose the amount of my benefits to Type or print the name of your agency Signature of person 1. Declaration of Payment Received through Child Support Services Division if ordered by a divorce decree, administrative order, or judgement. The Child Support Services Division (CSSD) shall fill out this section if disbursements are being paid directly to the applicant through CSSD or payments are being made through CSSD. Child support case number _________________ Monthly Child Support charged Monthly Spousal support charged Other _________ _________ _________ Child support case number ________________ Monthly Child Support charged _________ Monthly Spousal support charged _________ Other _________ Please attach last 12 months payment record received by custodial parent. Please attach last 12 months payment record received by non-custodial parent. Comments:______________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ____________________ Name of person completing form ___________ Title __________ Phone number ___________ Date 04-0950 (Rev 6/27/07) American LegalNet, Inc. www.FormsWorkFlow.com
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