This Notice is sent to inform you that
__________________________________________________________________
(Name of Consumer Credit Bureau of organization)
of _______________________________________________________________
(Address)
has requested information as to the arrearage you owe under your support Order through the Domestic Relations Section of the Court of Common Pleas of Mercer County, Pennsylvania. Our records indicate your arrearages are $ ________________ as of ______________ , 20___.
This information will be released to said Credit Bureau unless, within 20 days of this date, we receive a written objection from you contesting the accuracy of the calculated arrearages or stating a valid reason why the information should not be made available. _______________ , 20 ____
__________________________
Director, Domestic Relations
Merc. Cnty. Pa. 1930.9