STATEMENT FOR VERIFICATION OF CHILD SUPPORT
WZ Government of the Virgin Islands of the United States DEPARTMENT OF HUMAN SERVICES Office of Childcare & Regulatory Services STATEMENT FOR VERIFICATION OF CHILD SUPPORT I, , certify that I provide $ for support of my child/children. Weekly Bi-Weekly Monthly Bi-Monthly Name of Child or Children: Physical address: Signature Date Sworn To and Subscribed Before Me This Day of on St. Croix, USVI. Commission #: Exp. Date: Knud Hansen Complex Bldg. A * 1303 Hospital Ground « St. Thomas, Virgin Islands 00802 » (340) 774-0930 3011 Golden Rock ¢ Christiansted, St. Croix, Virgin Islands 00820 (340) 718-2980
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WZ Government of the Virgin Islands of the United States DEPARTMENT OF HUMAN SERVICES Office of Childcare & Regulatory Services STATEMENT FOR VERIFICATION OF CHILD SUPPORT I, , certify that I provide $ for support of my child/children. Weekly Bi-Weekly Monthly Bi-Monthly Name of Child or Children: Physical address: Signature Date Sworn To and Subscribed Before Me This Day of on St. Croix, USVI. Commission #: Exp. Date: Knud Hansen Complex Bldg. A * 1303 Hospital Ground « St. Thomas, Virgin Islands 00802 » (340) 774-0930 3011 Golden Rock ¢ Christiansted, St. Croix, Virgin Islands 00820 (340) 718-2980