The family responsibility office form is required by regulations under the Family Responsibility and Support Arrears Enforcement Act. It’s only used under the prescribed circumstances. The office only takes enforcement action on interest that has accrued as a result of payers’ failure. Below is a sample family responsibility office form.
Sample Family Responsibility Office Form
Case number______________
Support recipients name___________
Payer’s name____________
I am the support recipient under the following Order:
Court_________ Date of order_____________ Court file number__________
Agreement filed with court:
Date of agreement____________ Court agreement filed with__________ Court file No.______
The following amounts due under the agreement have not been paid.
Date payment due______ Amount_____ Date paid______ amount paid ______arrears_______
If you are entitled to interest on your support kindly indicate__________
Total arrears_________ Total interest rate%__________ Applicable interest__________
Sign in the presence of a lawyer, notary public or commissioner of affidavits present.
Sworn before me at the _________________ Date__________
Signature of commissioner______________ Date_________
