Free Warrant Cancellation Request Form - Texas


File Size: 43.9 kB
Pages: 2
Date: March 16, 2007
File Format: PDF
State: Texas
Category: Court Forms - Local
Author: OAGCSD
Word Count: 589 Words, 4,108 Characters
Page Size: Letter (8 1/2" x 11")
URL

http://www.oag.state.tx.us/AG_Publications/pdfs/1760ro.pdf

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Pag e 1 of 2 REQUEST FOR WARRANT CANCELLATION Note: A warrant cancellation request cannot be processed unless this form is completed to the fullest extent possible, signed and returned to the address listed at the bottom. Instructions are provided on page 2.

M ember's Data : OA G C ase Num ber: _______________________________ Non-cu stodial Parent's Nam e: _______________________________ Custodial Parent's Name: __________________________________ Custodial Parent's SSN: __________________________________ Wa rrant Being Cancelled: Payee: ___________________________________________________ M ailed To: ________________________________________________________________
(address)

Individual/Entity Requesting Warrant Cancellation and Replacement: Name: ____________________________________________________________________ Business or Entity/Title (if applicable): _________________________________________ Curren t Address: __________________________________________________________ Telephone N umber: _______________________________________________________ Addre ss Chang e Needed : G Yes

G No

Reason for Warrant Cancellation and Replacement: ____________________________________________ _________________________________________________________________________________________

I, __________________________, certify that I have not negotiated (cashed or deposited) and will not negotiate warrant number __________ in the amount of $__________ that was issued on ___________. By signing this form, I am agreeing that: to my knowledge, the above referenced warrant was either lost, damaged, or destroyed if the warrant was damaged and I have any portion of it, I will return it with this form to the address provided at the bottom of this letter if I receive this warrant in the future, I will return it to:
Texas Child Suppo rt Disb ursem ent Unit P.O. Box 659730 San Antonio, TX 78265-9730

and will indicate that the warrant is being returned because it was cancelled and a replacement warrant was reissued. A stop payment will be placed on the original warrant when this form is received. If I subsequently cash the original warrant, I will be responsible for the loss incurred by a merchant, a check cashing entity, or a government agency. I hereby agree that any such loss incurred by the State for honoring payment of the original warrant can be offset by the State recouping the amount of the loss from child support collections that would otherwise be disbursed to me. Signature of Requesting Party: _______________________________ Date: _____________ After signing this form, please return it to the address below:
Texas Ch ild Support Disbursem ent Unit Attn: Darlene Elizondo P.O. Box 659730 San Antonio, TX 78265-9730 FAX: (210) 921-2394
Form 1760 March 2007

Pag e 2 of 2

Instructions for Completing the Warrant Cancellation Request Form

1.

Complete all of the relevant lines of data on the upper portion of this form. If you are a(n): CP, you are not required to complete the"Business or Entity/Title" line NCP, you are not required to complete the: "Business or Entity/Title" line or "Custodial Parent's SSN" line

third party warrant recipient (someone other than the CP or NCP), you are not required to complete the: "Non-custodial Parent's Name" line "Custodial Parent's Name" line "Custodial Parent's SSN" line

2.

Complete the lines provided on the lower portion of the form, being sure to specify: your full name in the first line the warrant number in the second line the amount of the warrant being cancelled in the third line the issue date of the warrant being cancelled in the fourth line

Note: To obtain warrant information (such as the warrant number, amount or issue date), you can call 1-800-252-8014. 3. Sign the form in the "Signature of Requesting Party" line and record the current date in the "Date" line. Mail or fax this form to the address provided at the bottom of the form, which is: Texas Child Support Disbursement Unit Attn: Darlene Elizondo P.O. Box 659730 San Antonio, TX 78265-9730 FAX: (210) 921-2394

4.

Form 1760 March 2007