TRAVIS COUNTY DOMESTIC RELATIONS OFFICE
1010 Lavaca Street
P.O. BOX 1495
AUSTIN, TEXAS 78767
(512) 854-9696
FAX (512) 854-9819
www.traviscountydro.com
CUSTODIAL PARENT’S AFFIDAVIT OF DIRECT PAYMENTS
CAUSE NUMBER______________________ DRO ACCOUNT NUMBER_______________________
I____________________________________, the custodial parent: certify that either:
I have not received any support payments (in any form) directly from __________________________________, the
Non-custodial parent, including payments from a Trust Fund Escrow Account or Military Allotment, and any payments I
received were send to me from either the Domestic Relations Office or the State Disbursement Unit (SDU) or
the list of support payments provided below (including all dates and amounts) is a correct list of payments I received directly
from_________________________________, the non-custodial parent, and that these payments were not sent to me from
either the Domestic Relations Office or the State Disbursement Unit SDU).
I authorize and request the Domestic Relations Office to disclose this document in its entirety, to
_______________________________,(the person from
Whom the support payments were received) and file it with the court.
I certify that there is no court order in effect that prohibits the release of this information, and that this information will be used only for
Child Support purposes.
TOTAL OF ALL DIRECT PAY
MENTS: $ ______________________
Date
Amount Date Amount Date Amount Date Amount
_______________________________ ____________________________
Custodial Parent Date
STATE OF TEXAS
SUBCRIBED AND SWORN TO BEFORE ME on this ______________day of _________________________
___________________________________
Notary Public in and for the State of Texas
