Knud Hansen Complex Bldg. A • 1303 Hospital Ground • St. Thomas, Virgin Islands 00802 • (340) 774-0930  
3129 Golden Rock • Christiansted, St. Croix, Virgin Islands 00820 • (340) 772-7147  
 
 
 
 
 
 
Subsidy, Resource & Referral Program 
PATERNITY AND CHILD SUPPORT VERIFICATION FORM 
 
Kindly assist this client by providing the following information. 
Thank you. 
 
This is to verify that  
 
 
 
 
 
 SS#   
 
 
 
Has established a case at Paternity and child support against   
 
 
 
on behalf of the following child(ren). 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
o Support has been established in the amount of $ 
 per week/per month 
o Date of last payment  
 
 
 
 
. 
o Total child support paid in the last 12 months $  
 
 
. 
o This client has established a case; however, has not received any monies to 
date. 
 
 
Completed by: