CHARLES BACARISSE HARRIS COUNTY DISTRICT CLERK CHILD SUPPORT OFFICE 1115 CONGRESS, ROOM 10 HOUSTON, TEXAS 77002 (713) 755-6077 (713) 755-4359 Fax STOP PAYMENT FORM In order to allow for mail delivery please wait 10 business days from the date your payment is posted before submitting a stop payment request. However, stop payments can be submitted sooner if you agree to pay a $20 stop payment fee charged by the bank. After receiving a confirmation from our bank that the check is still outstanding, we will issue a replacement check to you within 2 to 3 business days. If the check has already been cashed, we will contact you by phone. Please submit a separate form for each check. Please complete all information below. (PLEASE PRINT) Cause Number __________________ Today’s Date: ________________ Payee’s Name ________________________________________________ Home Phone ( ___ ) ___________ Business Phone ( ___ ) ____________ ____________________ $___________________ _________________ Amount Date Warrant Number ____________________________________ Signature ____________________________ Driver’s License No. FINCS04 REV 04/07/00 American LegalNet, Inc. www.USCourtForms.com