Child Support Services Application For Scenario #3

Print, complete and send to the DCSS, along with copies of your three (3) most recent pay stubs and/or most recent state income tax return, the following forms:

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• Acknowledgment of Parental Relationship
• Application for Support Services
• Child Support Domestic Violence Notice
• Declaration in Lieu of Personal Testimony/Noncustodial Parent
• Declaration in Lieu of Personal Testimony Regarding Possible Paternity
• Health Insurance Information
• Income and Expense Declaration
• Notice to Custodial Parent Regarding Health Insurance
• Request for Support Services
• Visitation Verification

Download and retain copies of the following informational documents:

• Notice of Child Support Services Program
• Department of Child Support Services Fact Sheet
• Servicemembers Civil Relief Act (SCRA) Information Sheet

Return your completed application to the Sonoma County Department of Child Support Services:

If mailing, send to: Sonoma County DCSS, P.O. Box 6534, Santa Rosa, CA 95406

Drop off at: 1755 Copperhill Parkway Santa Rosa, CA

Once you send in your application, send any child support payments you receive to: California State Disbursement Unit, P.O. Box 989067, West Sacramento, CA 95798

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