IN THE DISTRICT COURT OF DOUGLAS COUNTY, NEBRASKA ___________________________ Plaintiff, vs. ___________________________ Defendant ) ) ) ) ) ) ) ) ) ) Docket______ Page______ AFFIDAVIT (Payee) (RE: Child Support Credit) ____________________, being first duly sworn upon oath deposes and states that: (Affiant) As Affiant, it is stated in my Decree, that Child Support is abated or reduced if the other party has the child(children) for visitation. I do hearby swear that visitation for the month(s) and year(s) listed below, request that credit be given for Child Support for the following: _______________________________ Exact days of visitation ________________________________________ Dollar amount to be credited as stated per decree or court order for visitation Affiant further swears that I realize that this affidavit is a binding legal document and that I, Affiant, request for the credit of the above listed amounts of child support to be reflected in the child support to off set the accrued due for the month(s) and year(s) listed above. Affiant also understands that no credit in excess of that which is stated in the decree or order can be given by the Clerk of the District Courts office. FURTHER AFFIANT SAITH NAUGHT, ______________________________________ Affiant Subscribed and sworn before me this day of__ , 20___. ________ NOTARY PUBLIC _____ CLERK OF THE DISTRICT COURT WILL ONLY ACCEPT ORIGINAL NOTARIZED FORM. American LegalNet, Inc. www.FormsWorkFlow.com Prtra51: 05/07