FAMILY COURT ______ CIRCUIT STATE OF HAWAI‘I SUPPLEMENTAL AFFIDAVIT RE: DIRECT PAYMENT CHILD SUPPORT CASE NUMBER FC-D NO. Preparer’s Name, Address and Telephone Number PLAINTIFF, vs. DEFENDANT. 1. My spouse and I have agreed that I shall pay child support directly to my spouse and not through the Child Support Enforcement Agency (CSEA). 2. Such an arrangement is in the best interest of our child(ren) because: 3. [ ] I affirm that all prior child support, ordered by the court or administratively, has been paid in a timely fashion. I have not been previously ordered to pay child support. [ ] 4. Our child(ren) do/does not receive public assistance, welfare, foster care, Social Security or other governmental assistance. 5. There are no outstanding debts owed to the Department of Human Services or other public assistance agencies by myself or my spouse. 6. I understand that at any time after the entry of our Divorce Decree, either party may void the direct payment arrangement and apply for services from the Child Support Enforcement Agency (CSEA) to receive payment through the agency. 7. I further understand that if our child(ren) receive(s) public assistance from the Department of Human Services, foster care payments or Social Security or if either parent applies to the CSEA for services, CSEA may immediately void the direct payment arrangement by sending written notice by regular mail to both parents at their last known addresses as set forth in our Divorce Decree or subsequent child support order. 8. Based upon the facts set forth herein, I ask this Court to approve direct payments of child support rather than requiring that child support payments be made through the CSEA. I declare that I understand that my signature under oath before a notary public is my solemn statement that I have read this affidavit and I know and understand the contents and that the statements are true, correct and complete to the best of my knowledge and belief. SIGNATURE SUBSCRIBED AND SWORN TO BEFORE ME ON THIS DATE: NOTARY PUBLIC’S SIGNATURE STATE OF HAWAI‘I MY COMMISSION EXPIRES: FOR COURT USE ONLY dirpay.aff - 11/98 American LegalNet, Inc. www.FormsWorkflow.com