Government of Ontario: Ministry of Community and Social Services

Family Responsibility Office
P.O. Box 220
Downsview, ON M3M 3A3

Notice of Re-Filing

Please complete this section to re-file your order with the Family Responsibility Office

FRO Case Number:

Name:

I am the: Person that pays support
Person that receives support

Street Address:

Apt #:

City:

Province:

Postal Code:

Country (if outside Canada)

Work Phone or Cell # ( ) –

Home Phone # ( ) –

FRO Client Signature:

Date: DD MM YYYY

Note: If you withdrew from FRO on or after October 31, 2004, you will need to complete the next section and pay a $50.00 fee to re-file. If you have any questions about this fee please call our office at 416-243-1909 or 1-888-815-2757 or visit our website at www.TheFRO.ca

If you withdrew from FRO prior to October 31, 2004, you do not need to complete the bottom section of this form. The fee does not apply to you.

Please complete this section only if you withdrew from the Family Responsibility Office on or after October 31, 2004.

The fee for re-filing with the Family Responsibility Office is $50.00.
Please select one payment method below: Cheque or Money Order (attached) Please make cheque or money order payable to the Minister of Finance
Visa
MasterCard
American Express

Credit Card Number:

Expiry Date: MM YYYY

Name of Cardholder:

I, Printed name authorize the Minister of Finance to charge my credit card for this $50.00 refiling fee.

Signature:

Date: DD MM YYYY

Return Completed Forms by Mail:
Family Responsibility Office
P.O. Box 696
Downsview, ON, M3M 3A9

Return Completed Forms by Fax:
(416)-240-2401

FRO–016 (11/02/2004)

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