AFFIDAVIT OF CHILD(REN)'S PHYSICAL
PRESENCE IN THE CARETAKER'S HOME
AFFIDAVIT
I, ____________________________________, the undersigned affiant
Name of the Affiant
do hereby certify and affirm that I am the caretaker of the minor child(ren) named below;
That I am the applicant/recipient of support enforcement services on behalf of the minor child(ren) whose name(s) appear(s) below;
That I have requested that the Department of Children and Family Services, Child Support Enforcement (DCFS, CSE) secure a court order to authorize the child support payments that are due and payable by the obligor and/or the obligee on behalf of the minor child(ren) whose name(s) appear(s) below to be redirected to me, the affiant, on behalf of the minor child(ren);
That I do hereby further certify and affirm that the minor child(ren) whose name(s) appear(s) below have been physically residing with me in my residence since ___________________, __________, located in the parish/county of ____________________, state of _________________.
Name(s) of Children | Date of Birth |
I solemnly swear or affirm that the foregoing statements are true and correct to the best of my knowledge and belief.
________________________
SIGNATURE OF AFFIANT
________________________
PRINT NAME OF AFFIANT
SUBSCRIBED AND SWORN TO BEFORE ME ON THIS _________ DAY OF __________________ AT __________________, LOUISIANA
______________________________________________
PRINT NAME OF ATTORNEY OR NOTARY PUBLIC
_____________________________________________
SIGNATURE OF ATTORNEY OR NOTARY PUBLIC
___________________________________________________
NOTARY NUMBER OF NOTARY PUBLIC OR BAR ROLL
NUMBER OF ATTORNEY
MY COMMISSION EXPIRES:__________________
AFFIDAVIT OF RECEIPT OF SERVICE AND NOTICE
AFFIDAVIT
I, _____________________________________________, an authorized
Name of the Affiant
representative of the Department of Children and Family Services, Child Support Enforcement hereby certify and affirm:
That support enforcement services are being furnished to _____________.
Caretaker
The following efforts have been made to give the obligor reasonable notice of the department's intent to redirect child support payments to the current caretaker. The obligor has not notified the department that (s)he objects to the redirection of support payments.
Date of Action | Action Taken |
The following efforts have been made to give the obligee reasonable notice of the department's intent to redirect child support payments to the current caretaker. The obligee has not notified the department that (s)he objects to the redirection of support payments.
Date of Action | Action Taken |
I solemnly swear or affirm that the foregoing statements are true and correct to the best of my knowledge and belief.
________________________
SIGNATURE OF AFFIANT
________________________
PRINT NAME OF AFFIANT
SUBSCRIBED AND SWORN TO BEFORE ME ON THIS ________DAY OF _____________ AT __________________, LOUISIANA
_______________________________________________
PRINT NAME OF ATTORNEY OR NOTARY PUBLIC
______________________________________________
SIGNATURE OF ATTORNEY OR NOTARY PUBLIC
___________________________________________________
NOTARY NUMBER OF NOTARY PUBLIC OR BAR ROLL
NUMBER OF ATTORNEY
MY COMMISSION EXPIRES:______________________________
La. R.S. § 46:236.1.12