Knud Hansen Complex Bldg. A • 1303 Hospital Ground • St. Thomas, Virgin Islands 00802 • (340) 774-0930
Knud Hansen Complex Bldg. A • 1303 Hospital Ground • St. Thomas, Virgin Islands 00802 • (340) 774-0930 3129 Golden Rock • Christiansted, St. Croix, Virgin Islands 00820 • (340) 772-7147 Subsidy, Resource & Referral Program PATERNITY AND CHILD SUPPORT VERIFICATION FORM Kindly assist this client by providing the following information. Thank you. This is to verify that SS# Has established a case at Paternity and child support against on behalf of the following child(ren). o Support has been established in the amount of $ per week/per month o Date of last payment . o Total child support paid in the last 12 months $ . o This client has established a case; however, has not received any monies to date. Completed by:
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Knud Hansen Complex Bldg. A • 1303 Hospital Ground • St. Thomas, Virgin Islands 00802 • (340) 774-0930 3129 Golden Rock • Christiansted, St. Croix, Virgin Islands 00820 • (340) 772-7147 Subsidy, Resource & Referral Program PATERNITY AND CHILD SUPPORT VERIFICATION FORM Kindly assist this client by providing the following information. Thank you. This is to verify that SS# Has established a case at Paternity and child support against on behalf of the following child(ren). o Support has been established in the amount of $ per week/per month o Date of last payment . o Total child support paid in the last 12 months $ . o This client has established a case; however, has not received any monies to date. Completed by: