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In
order for the WLTX-TV, News 19 On Your Side Team to assist you,
THE FOLLOWING INFORMATION MUST BE COMPLETED.
PRINT THIS FORM AND DROP OFF OR MAIL TO WLTX-TV.
WLTX-TV · 6027 GARNERS
FERRY ROAD ·
COLUMBIA, SC 29209
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| Custodial Parent Name. |
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| Custodial Parent Phone Number. |
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Absentee Parent Name and attach a Photograph.
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| Absentee Parent Current Address. |
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| Absentee Parent Phone Number. |
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| Case Number. |
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| Social Workers Name & Phone Number. |
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Has a Bench Warrant been served on the Delinquent Parent?
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YES CIRCLE
ONE NO
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| County in which child support was established. |
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| Dollar Amount in Arrears. |
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Additional Comments.
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