Fillable Record of Support Order (Attorney General of Texas)

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Record of Support Order (Attorney General of Texas)

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Figure: 1 TAC §55.121
Post Office Box 12017, Austin, Texas 78711-2017 Tel: (512)460-6000 1-800-252-8014
email: csd-sdu@oag.texas.gov or visit the Office of the Attorney General’s website (www.texasattorneygeneral.gov).
Form 1828A (ROS/App) August 2021
Record of Support Order
This completed form must be submitted to the county’s clerk of the court to set up the child support account. (See Texas Family Code §105.008)
Note to Clerks: Send the completed form to the State Case Registry/County Contact Team by fax 877-924-6872, e-mail csd-sdu@oag.texas.gov, or
mail to TxCSDU, P.O. Box 659400, San Antonio, TX 78265, or use the TXCSES Web Portal to provide this information in lieu of forwarding the
document to the TXSDU. In Dallas, El Paso, Harris, Tarrant, Taylor and Travis counties, the completed form must be sent to the Domestic Relations
Office.
Order Information
County Name:
Court Number:
Cause Number:
Attorney General Case Number:
Date of Hearing:
Order Sign Date:
Order Type:
New Order Modified Order
Payment Location:
State Disbursement Unit (SDU) Other:
By signing below, the party or attorney for the party requests child support services, also called Title IV-D services, for the benefit of
the family. (Note: Handwritten or electronic signatures are acceptable.)
Signature
: ____________________________ Date:
Typed/printed name: ____________________________
Signing person’s relationship to the case: Custodial Parent (CP) CP attorney Non-Custodial Parent (NCP) NCP attorney
Note to Counties: If the document is signed
above, and the Record of Support Order information was entered in the TXCSES Web Portal, the
document must be forwarded to the Office of the Attorney General by e-mail to csd-fax051@oag.texas.gov or by fax to (512) 781-7206. In
counties that forward the Record of Support Order directly to the State Case Registry/County Contact Team, no further action is required. In
Dallas, El Paso, Harris, Tarrant, Taylor and Travis counties, the document must be forwarded to the Domestic Relations Office.
Obligee/Payee/Custodial Parent Information
Family Violence Protection (FV) (Check if individual below is a victim of family violence)
Name:
Date of Birth:
Social Security Number:
Address:
City:
State:
Zip:
Sex: Male Female
Driver’s License Number:
Cell Phone:
Email:
Relationship to Child(ren):
Employer Name:
Address:
City:
State:
Zip:
click to sign
signature
click to edit
Figure: 1 TAC §55.121
Post Office Box 12017, Austin, Texas 78711-2017 Tel: (512)460-6000 1-800-252-8014
email: csd-sdu@oag.texas.gov or visit the Office of the Attorney General’s website (www.texasattorneygeneral.gov).
Form 1828A (ROS/App) August 2021
Attorney Information
Obligee Attorney:
Phone:
Obligor Attorney:
Phone:
Prepared by:
Phone:
Date:
County Name:
Court Number:
Cause Number:
Obligor/Payor/Non-Custodial Parent Information
Family Violence Protection (FV) (Check if individual below is a victim of family violence)
Name:
Date of Birth:
Social Security Number:
Address:
City:
State:
Zip:
Sex: Male Female
Driver’s License Number:
Cell Phone:
Email:
Relationship to Child(ren):
Employer Name:
Address:
City:
State:
Zip:
Dependent Information
Family Violence Protection (FV) (Check if dependent below is a victim of family violence)
Name:
Sex:
Male Female
Date of Birth:
Social Security Number:
Family Violence Protection (FV) (Check if dependent below is a victim of family violence)
Name:
Sex:
Male Female
Date of Birth:
Social Security Number:
Family Violence Protection (FV) (Check if dependent below is a victim of family violence)
Name:
Sex:
Male Female
Date of Birth:
Social Security Number:
Family Violence Protection (FV) (Check if dependent below is a victim of family violence)
Name:
Sex:
Male Female
Date of Birth:
Social Security Number:
If there are more children, attach an additional page listing the above information for each additional child.
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Record of Support Order (Attorney General of Texas)

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Completed 28 March 2022

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