IN THE _____ JUDICIAL CIRCUIT COURT, _____________________________ MISSOURI Judge or Division: Case Number: Petitioner(s): MACSS Case Number: vs. Respondent(s): (Date File Stamp) Affidavit of Credit for Child Support and/or Maintenance Owed to Custodial Parent (Partial or Complete Satisfaction of Child Support Judgment Pursuant to Section 454.432 RSMo.) I am the custodial parent in the above-named action. Direct Payment: I have received a direct payment from the non-custodial parent for: child support in the amount of $_____________________. maintenance in the amount of $_____________________. Credit for Purchase of Goods and/or Services Instead of Direct Child Support Payment (In-kind): I authorize credit for the purchase of goods and/or services to be given to the non-custodial parent’s child support/maintenance debt owed to me for the amount of $_____________________. Description of Purchase for In-kind Credit: ____________________________________________________ Partial or Complete Satisfaction: I acknowledge: partial satisfaction of the child support/maintenance judgment in the amount of $________________. complete satisfaction of the child support/maintenance judgment, excluding debt owed to the State. Explanation for Satisfaction: _______________________________________________________________ NOTE: Credit cannot be given for a payment not yet due (future). Credit may only be given for past-due child support/maintenance. I understand that this Affidavit cannot forgive any child support/maintenance owed to the State of Missouri. The State will continue to pursue collection of any child support/maintenance owed by the non-custodial parent to the State of Missouri. I further understand that this Affidavit does not prevent collection of any child support/maintenance owed to me at anytime in the future. The facts in this Affidavit are true to my best knowledge and belief and are made under penalty of perjury. ___________________________________ ______________________________________________ Date Signature ______________________________________________ Printed Name ______________________________________________ Address ______________________________________________ City/State Zip Code ______________________________________________ Phone In witness thereof: ___________________________________ ______________________________________________ Date Clerk Witnessing Signature Subscribed and sworn to before me on ________________________ (date). (Seal) My commission expires: __________________ Date ___________________________________ Notary Public Directions for Completing This affidavit must be completed and signature witnessed by a court clerk or notary before filing it with the court. OSCA (04-08) CS100 1 of 1 454.432, 511.570 RSMo American LegalNet, Inc. www.FormsWorkflow.com