Notice Of Determination Of Controlling Order
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Notice Of Determination Of Controlling Order Form. This is a Virginia form and can be use in District Court Statewide.
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Tags: Notice Of Determination Of Controlling Order, OMB-085H, Virginia Statewide, District Court
NOTICE OF DETERMINATION OF CONTROLLING ORDER
Date
IV-D Case: [
[
[
[
[
Obligor: Name (first, middle, last)
Social Security Number
] TANF
] IV-E Foster Care
] Medicaid Only
] Former Assistance
] Never Assistance
File Stamp
Non-IV-D Case: [ ]
Obligee: Name (first, middle, last)
Social Security Number
Responding FIPS Code
State
Responding IV-D Case Number
To:
Responding Tribunal Number
(Agency Name and Address)
Initiating FIPS Code
From:
(Contact Person, Agency, Address, Phone, Fax, E-mail)
State
Initiating IV-D Case Number
Initiating Tribunal Number
1 . On
(Date),
(Tribunal Name; County, State)
determined which order to recognize for prospective enforcement. The following orders were considered:
#
County
State
Date of Order
IV-D Case Number
Docket Number
Order Type
1
2
3
4
5
[ ] Additional orders listed on attached sheet.
2. [ ] The tribunal determined that order number ________ listed above is the controlling order for prospective support.
3. [ ] The tribunal determined that none of the existing orders is the controlling order for prospective support.
A new controlling order was entered; a certified copy is attached.
4. $_______________ per ____________________________ (frequency) is the current charging amount.
5. [ ] A reconciliation of arrears was completed: [ ] Yes
[ ] No
6. The tribunal calculated arrears to be $________________ as of _________________________ (Date).
A certified copy of the arrears reconciliation order is attached.
7. A copy of this notice (and certified copies of the controlling order determination and any arrears reconciliation order)
was also sent to:
_______________________________________________________________________________________________
Entity Name; State
_______________________________________________________________________________________________
Entity Name; State
[ ] Obligor
[ ] Obligee
[ ] Additional Entities Listed on Attached Sheet
Notice of Determination of Controlling Order
OMB 0970 -0085
Expiration Date: 01/31/2011
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