Indiana Child Custody FormIndiana Child Custody FormIndiana Child Custody Form
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Take or mail this completed form to
your county prosecutor’s office.

APPLICATION FOR TITLE IV-D CHILD SUPPORT SERVICES
State Form 34882 (R8 / 3-07) / CSB 425A
Approved by State Board of Accounts, 2006

PRIVACY STATEMENT
*The records in this series are confidential according to Indiana
Department of Child Services 42 USC 653, 42 USC 654, and
42 USC 663. This agency is requesting disclosure of personal
information that is necessary to accomplish the statutory
purposes of the agency as are also required by these statutes.
Disclosure of this information is mandatory. Failure to provide
any information may prevent this form from being processed.

INSTRUCTIONS:

1. Complete one application for each non-custodial parent for whom application is made.
INSTRUCTIONS (please read)

The Indiana Child Support Bureau offers child support services to persons desiring to obtain child support from a responsible parent outside
the home. These services are: Complete Service or Parent Locator Only Service