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CS-AP80

R. 03/11

Child Support Enforcement

Request for Authorization to Use the

State and Federal Parent Locator Service

Date: ___________________________

I hereby request Florida’s State Parent Locator Service (SPLS) to use its location resources and access the Federal Parent

Locator Service, and to provide location information about the following individual who is the parent or alleged parent of a

dependent child:

Name: ________________________________________________________________________________________

Social Security number: __________________________________________________________________________

Date of birth: ___________________________________________________________________________________

I hereby request Florida’s State Parent Locate Service (SPLS) to use its resources to identify and locate parents, relatives

or siblings of the following dependent child receiving foster care services.

Child’s Name: __________________________________________________________________________________

Social Security number: __________________________________________________________________________

Date of birth: ___________________________________________________________________________________

Note: SPLS information sources require certain identifying information for those sources to generate location responses.

Failure to provide a name and Social Security number (or date of birth if a Social Security number is unknown) will not allow

the SPLS to conduct location searches, resulting in a denial of this request.

PLEASE CHECK THE REASON FOR YOUR REQUEST.

UNAUTHORIZED USE OF STATE PARENT LOCATOR

INFORMATION MAY RESULT IN DENIAL OF FUTURE REQUESTS AND OTHER LEGAL SANCTIONS.

I certify under penalty of perjury that:

the requesting entity is acting on behalf of the petitioner to perform diligent searches as required by s. 39.503(5)-(7) or

39.803(5)-(7), F.S., or both.

the requesting entity is, pursuant to 42 U.S.C. s. 653, an “authorized person” and will use the information for the purpose of

establishing parentage, or establishing, modifying, or enforcing a support obligation.

the requesting entity is, pursuant to 42 U.S.C. s. 663, an “authorized person” and will use the information for the purpose of

enforcing any state or federal law with respect to the unlawful taking or restraint of a child or making or enforcing a child

custody or visitation determination.

_________________________________________

_______________________________________________

Name of Requesting Entity

Name of Entity Representative (Please Print)

_________________________________________

_______________________________________________

Mailing Address

Signature of Entity Representative

_________________________________________

(_____)______________

City, State Zip Code

Telephone Number

Fax Number

Please mail or fax the completed form to the following address:

Mailing Address:

Fax Address:

Florida Department of Revenue

Child Support Enforcement Program

ATTN: State Parent Locator Service

921 N. Davis St., Building A, Suite 370

FAX: (904) 359-2514

Jacksonville, FL 32209-6832

Social Security number disclosure is mandatory based on Title 42 United States Code sections 666(a)(13), 653a, and 654a(e),

and on section 409.2577, Florida Statutes. We collect social security numbers for child support purposes. For more

information go to

Cs-Ap80 - Child Support Enforcement - Request For Authorization To Use The State And Federal Parent Locator Service

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