Full Name of Party Filing Document

Mailing Address (Street or Post Office Box)

City, State and Zip Code

Telephone

Email Address (If any)

IN THE DISTRICT COURT FOR THE 		 JUDICIAL DISTRICT
FOR THE STATE OF IDAHO, IN AND FOR THE COUNTY OF 				

						,
		PETITIONER,
	vs.

						,
		RESPONDENT.

State of Idaho, Department of Health and Welfare	
Case No. 					

NOTICE OF INTENT TO TAKE
DEFAULT

TO:					, Deputy Attorney General for the State of Idaho Department of Health and Welfare:
 	You are notified Father intends to ask the Court to enter your default on his Motion to Modify on six days from the date of the Affidavit of Service below.      
Or
 	You are notified Mother intends to ask the Court to enter your default on her Motion to Modify on six days from the date of the Affidavit of Service below.      

CERTIFICATE OF SERVICE

I certify that on (date) 			 I served a copy to: (name all parties in the case other than yourself)

State of Idaho, Department of Health
And Welfare, Division of Child Support 
Enforcement

(Street or Post Office Address)

(City, State, and Zip Code)
	•	By mail
•	By fax (number) 			
•	By personal delivery
•	Overnight delivery/Fed Ex

				
(Name)

(Street or Post Office Address)

(City, State, and Zip Code)

•	By mail
•	By fax (number) 			
•	By personal delivery
•	Overnight delivery/Fed Ex	
				
(Name)

(Street or Post Office Address)

(City, State, and Zip Code)
	
•	By mail
•	By fax (number) 			
•	By personal delivery
•	Overnight delivery/Fed Ex

						
Typed/printed name

Typed/printed name

						
Signature (Father)

						
Signature (Mother)