IN THE CIRCUIT COURT FOR THE THIRTEEN JUDICIAL CIRCUIT OF THE STATE OF FLORIDA, IN AND FOR HILLSBOROUGH COUNTY - FAMILY LAW DIVISION _________________________ Petitioner Case No.: _____________________ vs Division: _________ _________________________ Respondent AFFIDAVIT TO INITIATE PARTICIPATION IN THE CENTRAL GOVERNMENTAL DEPOSITORY PROGRAM BEFORE ME, the undersigned Notary Public, the undersigned personally appeared, who having being first duly sworn according to law deposes and says; and I am the _____ Petitioner / ____ Respondent 1. My name is in the above styled cause. 2. Pursuant to a court order entered on or after January 1, 1985 I am entitled to receive alimony and/or child support payments. 3. The court order did not require that the said alimony and/or child support payments be made through the Central Governmental Depository. 4. Obligor/Payor has defaulted in his/her payments of alimony and/or child support and I hereby declare my wish to initiate participation in the Central Governmental Depository pursuant to Alimony Florida Statute 61.08(4)(d)(2) or Child Support Florida Statute 61.13(1)(d)(2). 5. One or both parties wish to initiate participation in the Central Governmental Depository Program. 6. I have provided the original of this affidavit, a completed Payment Information Sheet (Personal Information Form) along with a copy of the latest court order to Clerk of the Circuit Court Family Law Division, Room 101, Edgecomb Civil Courthouse, 800 Twiggs Street, Tampa, Florida 33602 and have by U.S. Mail provided a copy of this affidavit to the other party at the following address: _________________________________________________ _________________________________________________ _________________________________________________ FURTHER AFFIANT SAYETH NOT __________________________________________________ AFFIANT (signature) STATE OF FLORIDA COUNTY OF HILLSBOROUGH The foregoing instrument was acknowledged before me this _______________________________________________ day of , 20_____ , by (Commission Seal) _________________________________________________ Notary Public Signature __________________________________________________ Notary Printed Name Personally Known OR Produced Identification ___________________________________________ Type of Identification Produced ______________________________________________________________ CGD104 (10-31-08) American LegalNet, Inc. www.FormsWorkflow.com