State Referral: Federal Criminal Prosecution For Non-Support Form - Project Save Our Children - Office Of Child Support Enforcement Page 3

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STATE REFERRAL FEDERAL CRIMINAL PROSECUTION

FOR NON-SUPPORT (18 U.S.C. §228)

SECTION 7 – OTHER ELEMENTS

List enforcement efforts to date showing which other remedies have been attempted. What systems were used and dates?

Describe information relevant to establishing that the obligor has traveled interstate or internationally for the purpose of evading child support. Append

supporting documentation, including any tribunal order making such a finding.

Please attach a separate sheet outlining this information, if available. (Indicators or history of willful non-payment,

ability to make full or partial payment, obligor’s knowledge of obligation or other circumstances.)

SECTION 8 –

REFERRAL* (This section must be filled out completely.)

SIGNATURE OF AUTHORIZED OFFICIAL

The referring IV-D agency certifies:

The case is believed to meet statutory criteria for federal prosecution under 18 U.S.C.§228.

The state has exhausted all available and reasonable alternative enforcement remedies.

By ______________________________________

Date __________________ (mm/dd/yyyy)

NAME ___________________________________