Fillable IN THE CIRCUIT COURT, FOURTH JUDICIAL CIRCUIT, IN (Clay County Florida Clerk of Court and Comptroller)

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IN THE CIRCUIT COURT, FOURTH JUDICIAL CIRCUIT, IN (Clay County Florida Clerk of Court and Comptroller)

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IN THE CIRCUIT COURT, FOURTH JUDICIAL CIRCUIT,
IN AND FOR CLAY COUNTY, FLORIDA
,
Petitioner,
CASE NO.:
vs. DIVISION:
,
Respondent.
/
PETITIONER’S (PERSON RECEIVING PAYMENTS) CREDIT AFFIDAVIT
TO CONTINUE DIRECT PAYMENTS AND CLOSE DEPOSITORY CASE
I acknowledge that I have received $ for Case No. as of
, 20 from the respondent, , for
child support/alimony and I request that in the future he/she be allowed to continue making direct
payments, plus any arrearages, to me rather than pay through the Central Governmental Depository.
Signature of Petitioner (person receiving payments)
Printed Name
Address
City State Zip Code
Telephone
appeared before me and acknowledged that he/she signed the foregoing
this day of , 20 .
Notary Public, State of Florida
Seal
Check one only:
Personally known
Produced identification
Type of identification produced
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IN THE CIRCUIT COURT, FOURTH JUDICIAL CIRCUIT, IN (Clay County Florida Clerk of Court and Comptroller)

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Completed 30 July 2021

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