Your Name: Your Address: City, State, Zip: In this case I am PAYING RECEIVING money. In this case I am representing self have a lawyer Lawyer, Name & Bar No.: For Clerk’s Use Only SUPERIOR COURT OF ARIZONA IN MARICOPA COUNTY Case No. Petitioner ATLAS No. Respondent AFFIDAVIT OF DIRECT PAYMENTS YEAR YEAR YEAR YEAR (Insert year) January $ $ $ $ February $ $ $ $ March $ $ $ $ April $ $ $ $ May $ $ $ $ June $ $ $ $ July $ $ $ $ August $ $ $ $ September $ $ $ $ October $ $ $ $ November $ $ $ $ December $ $ $ $ By signing this document I state under penalty of perjury that I made the following payments directly to the person ordered to receive the payments or I received the following payments directly from the person ordered to make the payments. These payments were not made through the Support Payment Clearinghouse or the Clerk of the Court. Signature of Person Receiving Payments and/or Signature of Person Making Payments Affirmed before me on: Affirmed before me on: Deputy Clerk of Court or Notary Public Deputy Clerk of Court or Notary Public My Commission Expires/Seal: My Commission Expires/Seal: © Superior Court of Arizona in Maricopa County June 27, 2007 ALL RIGHTS RESERVED Page 1 of 1 DRMW32f Use most current version APM American LegalNet, Inc. www.FormsWorkflow.com