State Form 34882 (R17 / 3-20) / CSB 425A
1. 2. Take or mail the signed form to your County Child Support Office.
Complete this form by providing the requested information.
Specify assistance needed here (physical, hearing impaired, language interpreter, other)
I hereby swear and affirm under the penalties of perjury that the information contained in this form is true and correct to the best of