Request For Release Of Joint Federal Tax Refund Form. This is a Alaska form and can be use in Child Support Services Division Statewide.
Tags: Request For Release Of Joint Federal Tax Refund, 04-1806, Alaska Statewide, Child Support Services Division
Please Reply To: Alaska Department of Revenue CSSD, MS Child Support Services Division 550 W. 7th Ave., Suite 310 Anchorage, AK 99501-6699 www.csed.state.ak.us All Case Numbers: _______________________________ Member Number: _______________________________ Request for Release of Joint Federal Tax Refund ___ Please return our joint tax refund to us. ___ Please apply our joint tax refund to the cases listed above. Release money to the custodial parent(s) and return over-collected amount to us. I, __________________________________ , the non-custodial parent’s spouse, agree not to submit an injured spouse claim to the Internal Revenue Service (IRS) to replace the federal tax refund intercepted by the Child Support Services Division (CSSD). If any portion of the federal tax refund is reclaimed by the IRS, we understand that amount may be added to the arrears owed by __________________________________ , the non-custodial parent, and may be collected by withholding the non-custodial parent’s wages or by other enforcement remedies. Current employer’s name, address and phone number: ___________________________________ ___________________________________ ___________________________________ We understand and agree to the above. Non-Custodial Parent Non-Custodial Parent’s Spouse Signature: ______________________________ Date: ______________________________ Signature: ______________________________ Date: ______________________________ Print Name: _____________________________ SSN: _____________________________ Print Name: _____________________________ SSN: _____________________________ Address: ______________________________ ______________________________ Address: _______________________________ _______________________________ SUBSCRIBED AND SWORN to before me this date: ____________________________________ SUBSCRIBED AND SWORN to before me this date: ____________________________________ ____________________________________ Notary Public in and for Alaska My Commission Expires:________________ ____________________________________ Notary Public in and for Alaska My Commission Expires:________________ Note: If a notary is not available, the signatures may be verified and stamped by a U.S. Post Office representative. CSSD 04-1806 (Rev. 05/20/04) MAT-SU: (907) 357-3550 TOLL FREE (In-state, outside Anchorage): (800) 478-3300 SOUTHEAST: (907) 465-5887 ANCHORAGE: (907) 269-6900 FAX: (907) 269-6813 or 6914 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.USCourtForms.com