Person Filing: Address (if not protected): City, State, Zip Code: Telephone: Email Address: ATLAS Number: Lawyer222s Bar Number: Representing Self, without a Lawyer or Attorney for Petitioner OR Respondent SUPERIOR COURT OF ARIZONA IN MARICOPA COUNTY Case No. Petitioner ATLAS No. R espondent AFFIDAVIT OF DIRECT PAYMENTS YEAR YEAR YEAR YEAR (Insert year) January $ $ $ $ February $ $ $ $ March $ $ $ $ April $ $ $ $ May $ $ $ $ June $ $ $ $ July $ $ $ $ August $ $ $ $ September $ $ $ $ October $ $ $ $ Novembe r $ $ $ $ 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. SIGNATURES Signature of Person Receiving Payments and/or Signature of Person Making Payments Printed Name of Person Receiving Payments Printed Name of Person Making Payments STATE OF COUNTY OF Subscribed and sworn to or affirmed before me this: (date) By . Deputy Clerk or Notary Public (notary seal) STATE OF COUNTY OF Subscribed and sworn to or affirmed before me this: (date) By . Deputy Clerk or Notary Public (notary seal) For Clerk222s Use Only 251 Superior Court of Arizona in Maricopa County Page 1 of 1 DRMW32f 021618 ALL RIGHTS RESERVED Use most current version APM American LegalNet, Inc. www.FormsWorkFlow.com