Fillable Travis County - Request to Establish a Child Support Account

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Travis County - Request to Establish a Child Support Account

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TRAVIS COUNTY DOMESTIC RELATIONS OFFICE
REQUEST TO ESTABLISH A CHILD SUPPORT ACCOUNT
/DATE: _____ ______/___________ COURT CAUSE NUMBER:________________________________________
INFORMATION ABOUT YOUR COURT ORDER:
Has there been a court order signed/entered by the Court for the payment of child support: YES NO
What kind of order do you have: Divorce Paternity Temporary Protective Modification
INFORMATION ABOUT YOUR MARITAL STATUS:
Were you married to the person who is ordered to pay child support: YES NO
If YES what is the date of the marriage:_____/______/___________
INFORMATION ABOUT THE PERSON THE CHILD(REN) ARE LIVING WITH (PAYEE):
First name:________________________________ MI:________ Last Name:_____________________________________________
Mailing address:_____________________________________ City:___________________State:___________:Zip______________
Home phone: (_____) ______-_________ Work phone: (_____) ______-_________ Cell phone: (_____) ______-_________
Birthdate: _____/______/___________ SSN: XXX-XX-________ Language Spoken:____________________________
Driver’s License Number:__________________________________ Issuing State:________________________________
Type of Professional Licenses Held:__________________________________________ License #:___________________________
Ethnicity:______________ Sex:________ Ht.:___'____" Wt.:_________lbs. Hair color:__________ Eye color:____________
Employer phone: (Employer: _________ ________________________________________________ _____) ______-_________
Employer Address:__________________________________City:___________________State:_______________Zip:_____________
INFORMATION ABOUT THE PERSON PAYING CHILD SUPPORT (PAYOR):
First Name:________________________________ MI:________ Last Name:____________________________________________
City:Mailing address: _______________________ ______________ ___________________State:___________:Zip______________
Home phone: (_____) ______-_________ Work phone: (_____) ______-_________ Cell phone: (_____) ______-_________
Birthdate: _____/______/___________ SSN: XXX-XX-________ Language Spoken:____________________________
Driver’s License Number:__________________________________ Issuing State:________________________________
Type of Professional Licenses Held:__________________________________________ License #:___________________________
Ethnicity:______________ Sex:________ Ht.:___'____" Wt.:_________lbs. Hair color:__________ Eye color:____________
Please complete both pages in full
MORE INFORMATION ABOUT THE PERSON PAYING CHILD SUPPORT (PAYOR):
Employer:_____________________________________________ Employer phone: (_____) ______-_________
Employer Address:________________________________________________________________________________________
State:City: ______________________________________ ______ ___________________ Zip:__________________
INFORMATION ABOUT EACH CHILD:
CHILD #1 –
Full Name: ___________________________________________________ Sex:____________ Race:_______________________
Date of Birth:____/____/________ Place of Birth (City, State or City, Country):_________________________________________
Social Security # XXX-XX-_______
CHILD #2 –
Full Name: ___________________________________________________ Sex:____________ Race:_______________________
Date of Birth:____/____/________ Place of Birth (City, State or City, Country):_________________________________________
Social Security # XXX-XX-_______
CHILD #3 –
Full Name: ___________________________________________________ Sex:____________ Race:_______________________
Date of Birth:____/____/________ Place of Birth (City, State or City, Country):_________________________________________
Social Security # XXX-XX-_______
CHILD #4 –
Full Name: ___________________________________________________ Sex:____________ Race:_______________________
Date of Birth:____/____/________ Place of Birth (City, State or City, Country):_________________________________________
Social Security # XXX-XX-_______
CHILD #5 –
Full Name: ___________________________________________________ Sex:____________ Race:_______________________
Date of Birth:____/____/________ Place of Birth (City, State or City, Country):_________________________________________
Social Security # XXX-XX-_______
INFORMATION ABOUT THE PARTIES’ RELATIONSHIP TO THE ABOVE CHILD(REN):
What is the Payee’s relationship to the above child(ren): Mother Father Other (specify)______________________________
What is the Payor’s relationship to the above child(ren): Mother Father Other (specify)_____________________________
DRO 09/15/2010
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Travis County - Request to Establish a Child Support Account

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Completed 30 May 2020

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