SIGNATURE MUST BE NOTARIZED OR SIGNED BY DEPUTY CLERK
IN THE CIRCUIT COURT, FOURTH JUDICIAL CIRCUIT,
IN AND FOR CLAY COUNTY, FLORIDA
,
Petitioner,
vs. CASE NO.:
,
Respondent.
/
AGREEMENT FOR CREDIT FROM DIRECT PAYMENTS
I, , Payee, (person receiving payments), hereby agree and request the
Clay County Clerk of Court, Central Governmental Depository, to credit the account of
, Payor, (person making payments) in the amount of:
$ - child support $ -alimony
for payments of services provided directly to me. I understand this agreement will be made part of the Court file.
This credit is given because:
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Your court order states that support payments are to be paid through the Central Governmental Depository. A
payment made directly to the custodial parent (petitioner) by the non-custodial parent (respondent) may be
considered a gift.
There are some circumstances when a direct payment is necessary, but this form should only be used in an
emergency. Therefore, your signature below will verify that you have read and fully understand this
Agreement for Credit for Direct Payments form.
It does not give authorization to continue accepting direct payments. It is at the discretion of the Depository,
if this form will be accepted more than ONE time only. Your cooperation is requested in not asking for an
exception to this policy.
Warning: Failure to pay through the court as directed in your court order can result in a Notice of Delinquency
being issued by the Depository.
Signature of Payee (person receiving payments)
Print Payee Name
Address
City State Zip Code
Telephone
