Payment History Request
Chris Daniel, Harris County District Clerk
Child Support Department
This request is for cases prior to the establishment of the State Disbursement Unit (Year 2004). The
payment record reflects non-custodial parent payments received by the Harris County Child Support
Registry. You may need to contact the Office of the Attorney General for payments received after the
State Disbursement Unit (SDU) was established to ensure a complete record is obtained for the
specified case/cause number.
HARRIS COUNTY CAUSE NO_________________
IN THE ________ DISTRICT COURT
(If cause number not provided, $5 search fee is applied) (51.318(b)(3) Gov’t Code)
STYLE: ______________________________ VS. ______________________________
MAIL TO:
CHRIS DANIEL, DISTRICT CLERK
ATTENTION: CHILD SUPPORT DEPARTMENT
POST OFFICE BOX 4651
HOUSTON, TEXAS 77210
FAX TO:
(713) 755-4359
EMAIL TO:
CUSTOMER NAME: (Last, First, Middle)
_____________________________________________________________________________________
CUSTOMER TELEPHONE NUMBER: ____________________________________________________
CUSTOMER ADDRESS: _______________________________________________________________
CITY: _________________________________
STATE: _____
ZIP: ________________________
$1/page (51.318(b)(11) Gov’t Code)
HARRIS COUNTY CHILD SUPPORT PAYMENT HISTORY
How many copies? ___ (Certified at no additional charge)
Mail (Applicable Postage and Handling fees will be charged)
___
Request will be sent to address provided above.
___ Fax Express Return
Fax Number: _________________________________
* 4% Convenience fee of total cost will be applied when request is received by mail or fax.
I hereby authorize the Harris County District Clerk to charge my credit card for payment of the
services requested above:
Select One)
CREDIT CARD # _________________________________ EXPIRATION DATE: __________
NAME PRINTED ON CREDIT CARD:
______________________________________________________________________________
CREDIT CARDHOLDER ADDRESS (if different than above):
______________________________________________________________________________
AUTHORIZED SIGNATURE:
______________________________________________________________________________
FOR DISTRICT CLERK CHILD SUPPORT OFFICE USE ONLY
TRANSACTION NO: ________________________ RECIEPT NO: ______________________
HCCSPH160210