Elkhart County Child Support

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TITLE IV-D NON-CUSTODIAL PARENT NOTICE AND WAIVER

I, the undersigned non-custodial parent, hereby acknowledge that the Prosecuting Attorney is an agent of the State of Indiana and the Indiana Family and Children Services Administration, and DOES NOT serve as a private attorney for me. The function of the Office of the Prosecuting Attorney is to protect and promote the interests of the State at large and the best interests of the child(ren) in particular. These interests at times may or will conflict with my interests or desires and that I am willing to take on any consequences as to such.

I understand that the Prosecuting Attorney is only providing services as set out under Indiana and Federal Law. Furthermore, I realize that the Prosecuting Attorney's office is NOT my personal attorney and that I will at times need to consult with a private attorney or legal aid regarding my legal rights, including but not limited to dissolution, separation, paternity, custody, visititation, and property settlement. The Prosecuting Attorney's Office is in no position to give me legal advice. Any statements made by any of its staff will not be considered legal advice in an attorney-client relationship. Any information given by the Prosecuting Attorney's office will be considered by me as general information which will impose a duty upon myself to confirm independently.

I acknowledge that I am NOT entering into an attorney-client relationship with the Prosecuting Attorney's office, and that any confidential information provided to the Prosecutor's office is NOT information protected by an attorney-client relationship. As such, any information that I provided may be used against me by the Prosecuting Attorney's office in the prosecution of criminal offenses or civil violations without regard to the source of the information. I acknowledge that involving the Prosecuting Attorney's office does not protect me from prosecution for any criminal offense or civil action.

NOTE: THIS FORM IS A WAIVER OF LEGAL RIGHTS AND SHOULD BE SIGNED ONLY AFTER BEING READ CAREFULLY. YOUR SIGNATURE VERIFIES THAT YOU HAVE READ AND UNDERSTAND THE CONTENTS OF THIS DOCUMENT.

I have read the above and fully understand the contents of this waiver and consent to its terms. I affirm under the penalties of perjury that the foregoing representations are true.

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Office of the Prosecuting Attorney, 301 S. Main St., Suite 100, Elkhart, IN 46516 | P: (574) 522-3074 | F: (574) 522-4965
www.elkhartcountyprosecutor.com