DISCLAIMER OF ATTORNEY-CLIENT RELATIONSHIP/COOPERATION LETTER

DISCLAIMER OF ATTORNEY-CLIENT RELATIONSHIP/COOPERATION LETTER
Obligor Name:*
CSEA SETS Number:
Please be advised that the Attorneys for the Montgomery County Child Support Enforcement Agency (MCCSEA) are not acting as your private attorneys. An attomey-client relationship has not been, and will not be, established. The attorney is a representative of the MCCSEA. Please sign and return this document to the CSEA within 30 days.

I hereby acknowledge that I have read this notice and understand its content.
Your Name*
Signature*

Clear

Legal Cooperation Letter
Your Name:*
The Child Support Enforcement Agency (CSEA) needs your help to pursue legal action on this case. If you are willing to cooperate, we will initiate action to file in court. You must also attend at least one court hearing. If you would like the CSEA to pursue legal enforcement, please check the appropriate box and return this form along with the included Disclaimer of Attorney-Client Relationship to the CSEA within 30 days.

If you do not want to cooperate, this is your notice of the CSEA's intent to close your case, if your case is eligible for termination of IV-D Child Support Services. This notice is being provided pursuant to Ohio Administrative Code $5101:12-10-70(G If you want IV-D services to continue, please check the appropriate box and return this form within 30 days. If the CSEA does not receive this request within 30 days of the date on this notice, the CSEA will not pursue legal enforcement on your case, and may terminate IV-D services entirely.

Please be advised that terminating IV-D services will not stop current support from charging or remove any arrearages due to you. If you subsequently wish to have our agency pursue enforcement, you will need to contact our office and complete a new application for IV-D services.

If you have questions, please call (937)225-4600 or chat with a live representative from 8am- 5pm at http://www.mcsea.org/.
Please check the box that indicates your preference:*

I want my IV-D case to remain open and promise to cooperate with your legal division by completing paperwork and attending court hearings, as needed.Please terminate IV-D Child Support Services if my case is eligible for termination.

If you have information that could help the CSEA collect the support owed to you, please complete and return this Obligor Information form. Thank you!
CSEA SETS Number
Obligor's Name
Obligor's Address
To your knowledge, is the obligor working?

YesNo
Employer
Location and/or phone# of employer:
List any recreational or professional licenses
Does the obligor own any property?

YesNo
If yes, please provide location.
Other Info
What's your address?

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Your Phone Number:
Signature

Clear
Should be Empty:

DISCLAIMER OF ATTORNEY-CLIENT RELATIONSHIP/COOPERATION LETTER

Legal Cooperation Letter