APPLICATION FOR SERVICES OF CHILD SUPPORT SERVICES DIVISION Notice to Court Clerk If this application is filed with the court, send the application along with a copy of the child support order to CSSD. Court Case No. I voluntarily apply for the services of the Child Support Services Division (CSSD). I understand that CSSD will take all action necessary to enforce the child support order for the child(ren) named below. I consent to CSSD's enforcement of the medical support order. I understand that either party may ask CSSD to review the amount of the child support order and propose changes to the court. I also understand that I will be required to provide information necessary to enforce the support obligation. My Name Mailing Address (box or street number) Telephone Number. Home Other Parent's Name Mailing Address (box or street number) Telephone Number. Home (city) Work Non-Parent Custodian of DOB DOB DOB (state) (ZIP) (city) Work (state) (ZIP) Mother Father Legal Custodian I am the the child(ren) whose name(s) and date(s) of birth are: DOB DOB DOB A child support order is currently in effect: Date of child support order: Court case number: Court location (city and state): Names of parents when child support was ordered: Date Applicant's Signature * AS 25.27.265(b) requires parties to child support proceedings to inform CSSD of their social security numbers and other specified information. Your social security number may be used to insure compliance with the child support order. You must provide your social security number on form DR-314. The information on DR-314 will be held confidential. DR-315 (10/06)(cs); CSSD 04-1017c APPLICATION FOR SERVICES OF CHILD SUPPORT SERVICES DIVISION AS 25.27.100 and .103 Civil R. 90.1(f)(1) American LegalNet, Inc. www.FormsWorkflow.com