IN THE CIRCUIT COURT IN AND FOR ESCAMBIA COUNTY, FLORIDA FAMILY LAW DIVISION _____________________________, Petitioner Case Number: __________________ Division: ______________________ Vs. DEP ACCOUNT#:______________ _____________________________, Respondent PETITION TO TERMINATE CHILD SUPPORT AND/OR ALIMONY The undersigned Petitioners, being under a Court Order to pay and receive child support/ alimony payments through the designated depository, request the Court to terminate the child support/alimony provision of the Order effective the _____ day of ___________________, _______. 1. The reason for this request is as follows: ______ On that date the petitioners were married. ______ On that date the petitioners began co-habitation without marriage. ______ On that date the child(ren), ___________________________________________ began residing with the payor. ______ Other: ___________________________________________________________ ___________________________________________________________ 2. Petitioners ___ are ___ are not currently receiving Aid to Families with Dependent Children (AFDC) or other public assistance benefits from the State of Florida. 3. Petitioners ___ have ___ have not received AFDC or other public assistance benefits from the State of Florida in the past. PAYOR: PAYEE: ___________________________________ (Signature) ___________________________________ Name - typed or printed ___________________________________ Address ___________________________________ ____________________________________ (Signature) ____________________________________ Name - typed or printed ____________________________________ Address ____________________________________ ___________________________________ ____________________________________ Page 1 of 2 American LegalNet, Inc. www.FormsWorkflow.com The foregoing instrument was acknowledged before me this ______ day of ____________________________, 20____, who is either personally known to me or who produced ____________________________ as identification, and who ____ did ____ did not take an oath. ERNIE LEE MAGAHA, CLERK BY: ______________________________________ Deputy Clerk or __________________________________________ NOTARY PUBLIC - STATE OF FLORIDA (SEAL) The foregoing instrument was acknowledged before me this ______ day of ____________________________, 20____, who is either personally known to me or who produced ____________________________ as identification, and who ____ did ____ did not take an oath. ERNIE LEE MAGAHA, CLERK BY: ______________________________________ Deputy Clerk or __________________________________________ NOTARY PUBLIC - STATE OF FLORIDA (SEAL) Page 2 of 2 American LegalNet, Inc. www.FormsWorkflow.com