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Title IV-D Notice And Waiver Form. This is a Indiana form and can be use in Elkhart Local County.
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Tags: Title IV-D Notice And Waiver, Indiana Local County, Elkhart
STATE OF INDIANA
COUNTY OF ELKHART
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TITLE IV-D NOTICE AND WAIVER
I, the undersigned custodial parent or custodian, hereby acknowledge that the
Prosecuting Attorney is an agent of the State of Indiana and the Indiana Family and
Social Services Administration, and cannot and does not serve as a private attorney to
custodial parents or other custodians. The function of the Office of the Prosecuting
Attorney is to protect and promote the interests of the State at large and the best interests
of children in particular, and these interests may conflict at times with my interests or
desires.
I understand that the Prosecuting Attorney does not actually represent custodial
parents or custodians, but is merely providing child support services under Title IV-D of
the Federal Social Security Act. These services are limited to: (1) location of absent
parents; (2) establishment of paternity and other support orders; (3) enforcement of
support orders; and (4) modification of support orders. Furthermore, I realize that the
Prosecuting Attorney is not my personal attorney, and that I may need to consult with a
private attorney or a legal services agency regarding my legal rights, including but not
limited to dissolution, separation, paternity, custody, visitation, and property settlement.
I acknowledge that I am not entering into an attorney-client relationship with any
attorney in the Office of the Prosecuting Attorney, and that any confidential information
provided to the Prosecutor’s Office is not information protected by and attorney-client
relationship. As such…any information provided to the Office of the Prosecuting
Attorney may be used by that Office in the prosecution of criminal offenses or civil
violations without regard to the source of the information. I further acknowledge that
involvement in the Title IV-D Child Support Program does not protect me from
prosecution of any criminal offense or civil infraction.
NOTE: THIS FORM IS A WAIVER OF LEGAL RIGHTS AND SHOULD BE SIGNED
ONLY AFTER BEING READ CAREFULLY. YOUR SIGNATURE VERIFIES THAT
YOU HAVE READ AND UNDERSTAND THE CONTENTS OF THIS DOCUMENT.
I have read the above and fully understand the contents of this waiver and consent
to its terms. I affirm under the penalties of perjury that foregoing representations are
true.
Date:
Signature of Custodial Parent/Custodian
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