Alaska Department of Revenue Please Reply To: CSSD, MS 550 W. 7TH Ave., Suite 310 Anchorage, AK 99501-6699 Child Support Services Division ___________________________ Petitioner Child Support Case No. ____________ ___________________________ Respondent Affidavit of Military Service State of Alaska ____________ Judicial District ) ) ss ) I, __________________________ on oath state: With respect to ____________________________________________________________ He/She is He/She is not I am unable to determine whether he/she is (Check the appropriate box) in the military service of the United States: This affidavit is based on the following facts: ______________________________________________________________________________________ ______________________________________________________________________________________ ______________________________________________________________________________________ ___________________________ Signature of Affiant Signed and sworn to before me this ___ day of __________________, 20____ . _______________________________ Notary Public for the State of Alaska My commission expires: _______________ CSSD 04-0004 (Rev 4/13/11) MAT-SU: (907) 357-3550 TOLL FREE (In-state, outside Anchorage): (800) 478-3300 SOUTHEAST: (907) 465-5887 ANCHORAGE: (907) 269-6900 FAX: (907) 787-3220 FAIRBANKS: (907) 451-2830 TDD machine only: (907) 269-6894 / TDD machine only, toll free (In-state, outside Anchorage): (800) 370-6894 American LegalNet, Inc. www.FormsWorkFlow.com