Family Responsibility Office Contact Form

July 2, 2011

The family responsibility office contact form is the central point where child support payments and back child support or child support arrears in separation agreements or divorce or family court orders are filed. The office is authorized to collect money directly. Below is a sample family responsibility office contact form.

Sample Family Responsibility Office Contact

Client’s full name ________________________Date of birth_________________

Full address _______________Phone_________________


Other parties full name ________________Date of birth _________________

Full address__________________

Date of marriage ________________Date of separation or divorce ______________

Date of cohabitation ___________________Previous divorce_______________ date______

Name of child_____________ DOB ________________School _____________Grade _

Resides With _______________

Do you receive/pay child support? _________________

Do you have any arrears related to Family Responsibility Office? __________

Have you been convicted for defaulting in payment? ___________________

Do you have legal representation with regard to child support obligations? ____________

I agree to follow guidelines of child support obligations.

Signature and Date_________________ Lawyers name and Signature___________



Download Family Responsibility Office Contact Form in Word Format

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