In the Circuit Court of Jackson County, Missouri s1

IN THE CIRCUIT COURT OF JACKSON COUNTY, MISSOURI

______Petitioner, and Case No. ______

______Respondent. AFFIDAVIT OF CREDIT BY CUSTODIAN PARENT

Custodial Parent: ______Non-Custodial Parent ______

Direct Payment: I have received a direct payment for child support/maintenance in the amount of $______from the non-custodial parent. Note: Credit may only be given for past-due support debt. NOTE: Credit may not be given for a payment not yet due. Credit for direct payment on all open IVD cases must be reported directly to the appropriate case worker.

Explanation of Credit: ______

Payment Forgiven: I hereby forgive the non-custodial parent’s child support/maintenance past-due support debt in the amount of $______. NOTE: Credit may not be given for a payment not yet due. Credit for a direct payment on all open IVD cases must be reported directly to the appropriate case worker.

The facts in this Affidavit are true to my best knowledge and belief and are made under penalty of perjury.

______(Date) Custodial Parent’s Signature

This affidavit must be completed and signature witnessed by a court clerk or notary before filing with the court.

In witness thereof:

______Date Court Clerk Witnessing Signature

Subscribed and sworn to before me on ______

My commission expires:______Date Notary Public Send all completed forms to:

Department of Civil Records Child Support Section 415 E. 12th Street - Room 305 Kansas City, Missouri 64106-2706

CIRCT 1426A – 03-08