Child Support Enforcement - Request For Refund Denied
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3CS-FM127
N. 07/10
Rule 12E-1.0051
Child Support Enforcement
Florida Administrative Code
Effective10/11
Request for Refund Denied
Date: ___________________________
CSE Case Number: ________________
Other Parent: _____________________
We are denying your request to refund a support payment(s) for $
because:
We applied the payment(s) to make up for our loss because of your bad check.
We applied the payment(s) to recover an overpayment you did not repay the Department.
We applied the payment(s) to recover an overpayment the other parent did not repay the
Department.
We applied the payment(s) to current or past-due support you owe the State on the above case.
We applied the payment(s) to costs owed the State on the above case.
We applied the payment(s) to your other cases.
The other parent on the above case already reclaimed the payment(s).
Other:
____________________________________________________________________________
____________________________________________________________________________.
You did not provide the information we asked for. We are sending back your request. We will
review your request again, once you provide us with the information.
We need: ____________________________________________________________________
____________________________________________________________________________.
Return this form and your request with the information we need to:
Child Support Enforcement
Attn: Payment Processing Unit
P.O. Box 8030
Tallahassee, FL 32314-8030
If you disagree with our decision, you may file a petition for administrative hearing within 20
calendar days from the date of this notice. The attached Notice of Rights tells you how.
To contact us, call 1-850-617-8119 and ask for the Payment Processing Unit.
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