Family Responsibility Office Form

July 2, 2011

The family responsibility office form is required by regulations under the Family Responsibility and Support Arrears Enforcement Act. It’s only used under the prescribed circumstances. The office only takes enforcement action on interest that has accrued as a result of payers’ failure. Below is a sample family responsibility office form.

Sample Family Responsibility Office Form

Case number______________

Support recipients name___________

Payer’s name____________

I am the support recipient under the following Order:

Court_________   Date of order_____________    Court file number__________

Agreement filed with court:

Date of agreement____________ Court agreement filed with__________ Court file No.______

The following amounts due under the agreement have not been paid.

Date payment due______ Amount_____ Date paid______ amount paid ______arrears_______

If you are entitled to interest on your support kindly indicate__________

Total arrears_________ Total interest rate%__________ Applicable interest__________

Sign in the presence of a lawyer, notary public or commissioner of affidavits present.

Sworn before me at the _________________ Date__________

Signature of commissioner______________ Date_________


Download Family Responsibility Office Form in Word Format

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