IN THE CIRCUIT COURT OF THE FOURTH JUDICIAL CIRCUIT IN AND FOR DUVAL COUNTY FLORIDA CASE NO.: 16DIVISION: FM, Petitioner And , Respondent NOTICE OF SERVICE TO DEPARTMENT OF REVENUE/CHILD SUPPORT ENFORCEMENT (DOR/CSE) BY CERTIFIED MAIL RETURN RECEIPT REQUESTED I HERE BY CERTIFY that the Dept. of Revenue/Child Support Enforcement Unit was served with a copy of: Motion (full name of pleading) Other Documents/Forms -DR-FM By Certified Mail, Return Receipt Requested, Receipt No , at Department of Revenue/Child Support Enforcement, ATTN: Service Center Manager Bldg. A ­ Room 150, 921 N. Davis Street, Jacksonville, FL 32209, on (month and day) , 20 as shown by the signed certified mail card (attached to this notice). Signature Address: Telephone: ATTACH CERTIFIED MAIL CARD HERE FCS (Duval) Local Form ­ Revised 11/20/14 American LegalNet, Inc. www.FormsWorkFlow.com