Notice And Acknowledgment To Child Support Enforcement Division (Page 2 of 2) in pdf

Notice And Acknowledgment To Child Support Enforcement Division Page 2

CERTIFICATE OF SERVICE

I hereby certify that a copy of the foregoing Notice and Petition for Dissolution were served

upon the following by mailing true and correct copies on the ____ day of ________________,

20____, postage prepaid and addressed as follows:

Department of Public Health and Human Services

Attorney General

Child Support Enforcement Division

215 N. Sanders, Third Floor

P.O. Box 201401

Helena, Montana 59620-1401

DATED this ______ day of ____________________, 20___.

____________________________________

Petitioner Pro Se

ACKNOWLEDGMENT OF SERVICE OF NOTICE

I, the undersigned, hereby acknowledge that I received a copy of the Petitioner’s Notice to

Child Support Enforcement Division and a copy of the Petition in the above-entitled action.

DATED this _____ day of __________________________, 20___.

By: ___________________________________

DECLINATION BY DEPARTMENT OF PUBLIC HEALTH AND HUMAN SERVICES

The Department of Public Health and Human Services declines to enter this proceeding as

a party.

DATED this _____ day of ____________________________, 20_____.

By:

DPHHS, Child Support Enforcement Division

Notice to CSED, Page 2 of 2

Approved by the Montana Supreme Court Commission on Self-Represented Litigants and Montana Legal Services Association, 7/24/02

Notice And Acknowledgment To Child Support Enforcement Division Page 2