Read Microsoft Word - Child Support Letter.doc text version

Sample Child Support Letter

Today's Date:______________________________ Healthy Families/Medi-Cal for Families P.O. Box 138005 Sacramento, CA 95813-8005 Dear Healthy Families and Medi-Cal for Families, I, _______________________________________ pay child support for the child(ren) listed below. (First and last name of person paying child support) __________________________

(child's name)

_$_________________

(amount child receives)

_______________

(how often it is paid) [Weekly, every 2 weeks, twice a month, monthly]

__________________________

(child's name)

_$_________________

(amount child receives)

_______________

(how often it is paid) [Weekly, every 2 weeks, twice a month, monthly]

__________________________

(child's name)

_$_________________

(amount child receives)

_______________

(how often it is paid) [Weekly, every 2 weeks, twice a month, monthly]

__________________________

(child's name)

_$_________________

(amount child receives)

_______________

(how often it is paid) [Weekly, every 2 weeks, twice a month, monthly]

__________________________

(child's name)

_$_________________

(amount child receives)

_______________

(how often it is paid) [Weekly, every 2 weeks, twice a month, monthly]

Sincerely, ____________________________________

Signature of person paying child support

*

*

*

*

*

To be filled out by person applying for Healthy Families:

Name: ______________________________________________________

Address: _____________________________________________________

Telephone Number: ____________________________________________

FMN# (If you have it): ___________________________________________

Child Support Letter Rev. 01/2008

Information

Microsoft Word - Child Support Letter.doc

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Microsoft Word - Child Support Letter.doc