NON-CUSTODIAL PARENT PAYMENT FORM

 

First Name

_______________________

Last Name

_______________________

Social Security Number

_______________________

Docket Number

_______________________

Issuing County

_______________________

Payment Amount

_______________________

Name of the Custodial Parent

______________________________

Address of the Custodial Parent

_____________________________________________

 

_____________________________________________

City

___________________ State _______  Zip__________

 

 

 

 

 

 

 

You must send your child support payment to:

 
 

 

 


Illinois State Disbursement Unit
P. O. Box 5400
Carol Stream, IL 60197-5400

 

Make your check or money order payable to: Illinois State Disbursement Unit