Form Cssd 04-1013 - Cssd Check Reissue Request, Form Cssd 04-0008 - Authorization Form For Visa Debit Card Or Direct Deposit To Bank Account

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Alaska Department of Revenue
Please Reply To:
Child Support Services Division
CSSD, MS 12
th
550 W. 7
Ave., Suite 310
Anchorage, AK 99501-6699
CSSD Check Reissue Request
Date of Request:
Case Number:
Name:
Address:
If New Address:
Check number:
Check number:
Amount of Check:
Amount of Check:
Date Issued:
Date Issued:
Please issue a Stop Pay on the above noted check(s) for the following reason:
Never Received
Lost
Stolen
Other
I agree not to cash this/these check(s) if received and will return it/them to the Child Support
Services Division. If I cash this/these checks I am giving CSSD permission to automatically
recover these amounts from Future Monthly Support Obligations.
Signature
Printed Name
Date received in SDU
Date request completed
CSSD 04-1013 (Rev: 06/13/11)
MAT-SU: ( 907) 357-3550
TOLL FREE (In-state, outside Anchorage): (800) 478-3300
SOUTHEAST: (907) 465-5887
ANCHORAGE: (907) 269-6900
FAX: (907) 787-3322
FAIRBANKS: (907) 451-2830
TDD machine only: (907) 269-6894 / TDD machine only, toll free (In-state, outside Anchorage): (800) 370-6894

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