SDU ABA/TRC:
|
333333336
|
SDU account number:
|
123454321
|
SDU account type:
|
Checking
|
SDU name:
|
Family Services Dept.
|
Identification number (optional):
|
PDC-17204
|
Case identifier:
|
NV-186-21745
|
Default payment amount (optional):
|
$ 100.00
|
Non-custodial parent SSN:
|
123456789
|
Medical support indicator:
|
No
|
Non-custodial parent name (optional):
|
ASmith
|
FIPS code of the receiving SDU (optional):
|
32888
|
Employment termination indicator (optional):
|
No
|
|