LaGrange County Child Support
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Admin Dispute
Please fill in the form below.
Date
(mm-dd-yyyy)
ISETS#
Dispute Type
Arrears (back support)
Bank Garnishments
Credit Bureau Notice
License Suspension (driver, hunting, fishing, professional, etc)
Liens
Passports
Tax Refund Seizure
Other
Custodial or Non-Custodial Parent
Last Name
First Name
Middle Initial
SSN
Phone
Email
Street Address
City
State
Zip
Other Party Details
Name
SSN
Phone
Street Address
City
State
Zip
Employer Details
Employer Name
Phone
Address
City
State
Zip
Comments (Please state what action or information you are requesting. Please be as specific as possible)
Signature
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