IN THE CIRCUIT COURT IN AND FOR ESCAMBIA COUNTY, FLORIDA FAMILY LAW DIVISION _____________________________, Petitioner Case Number: __________________ Division: ______________________ Vs. DEP ACCOUNT#:______________ _____________________________, Respondent PETITION FOR CREDIT FOR DIRECT PAYMENT OF CHILD SUPPORT/ALIMONY The undersigned Petitioners, under Court Order dated _____________________ to pay and receive child support/alimony payments through the designated depository, request the Court give credit for the total amount of $_____________________ for support payments made directly between the parties. Proof of those payments are filed with this petition. 1. Petitioners ( ) are ( ) are not currently receiving Aid to Families with Dependent Children (AFDC) or other public assistance benefits from the State of Florida. 2. Petitioners ( ) have ( the State of Florida in the past. 3. Petitioners ( Enforcement Office. ) have not received AFDC or other public assistance benefits from ) do ( ) do not have an case with the Department of Revenue Child Support 4. Petitioners understand that credit will not be given for future payments made directly between the parties instead of through the central depository. STATE OF FLORIDA COUNTY OF ______________________________ SWORN to and subscribed before me this _______ day of ____________________, 20_____ ( ) Personally known to me ( ) Produced Identification:___________________ ___________________________________(SEAL) NOTARY PUBLIC - STATE OF FL __________________________________ PAYEE'S Signature ___________________________________ Name - typed or printed ___________________________________ Street Address ___________________________________ City, State, Zip Code ___________________________________ Telephone Number or ERNIE LEE MAGAHA Clerk of the Circuit Court BY:________________________________(SEAL) Deputy Clerk Page 1 of 2 American LegalNet, Inc. www.FormsWorkflow.com _____________________________, Petitioner Case Number: __________________ Division: ______________________ Vs. _____________________________, Respondent STATE OF FLORIDA COUNTY OF ______________________________ SWORN to and subscribed before me this _______ day of ____________________, 20_____ ( ) Personally known to me ( ) Produced Identification:___________________ ___________________________________(SEAL) NOTARY PUBLIC - STATE OF FL DEP ACCOUNT#:______________ Direct Payment of Child Support/Alimony ___________________________________ PAYOR'S Signature ___________________________________ Name - typed or printed ___________________________________ Street Address ___________________________________ City, State, Zip Code ___________________________________ Telephone Number or ERNIE LEE MAGAHA Clerk of the Circuit Court BY:________________________________(SEAL) Deputy Clerk If only one party has signed: Copy Sent to _____Payor _____Payee this _______, day of ________________________, 20____. Page 2 of 2 American LegalNet, Inc. www.FormsWorkflow.com