STATE OF SOUTH CAROLINA ) ) COUNTY OF ________________________ ) ) ) ) Plaintiff, ) vs. ) ) ) Defendant. ) IN THE FAMILY COURT _____JUDICIAL CIRCUIT AFFIDAVIT OF ARREARS Docket No. ___________________________ 1. 2. 3. 4. 5. 6. 7. DIRECTIONS Calculate each month separately. Do NOT keep a running balance. The total DUE minus the total PAID equals the total BALANCE. The "amount due and owing" in the affidavit is calculated by adding the balance columns for each year. If your support order requires that the Plaintiff/ Defendant pay medical and/or dental bills, you may include these on your Affidavit. Calculate these separately from your ongoing support. Attach copies of these bills, if you have them, to your Affidavit to support your claim. Attach a TRUE or CERTIFIED copy of any pay records that a court or other collection entity has maintained on payments made pursuant to the support order. The signature of the affiant must be notarized. Attach additional sheets as necessary. AFFIDAVIT ____________________________, who being duly sworn, states under oath that the following attachment, incorporated herein by reference, is a schedule of support payments and balances due her/him, as obligee, based on the order entered in the State of _______________________, dated __________________________, 20___ requiring ____________________________, the obligor, to make support payments in the amount of $____________ per _______. That the amount of $____________ is due and owing as arrears from the period beginning ____________________________, ______ and ending _______________________, ______. Sworn to before me this ______ day of _______________, 20___ Notary Public for South Carolina My Commission expires ___________, 20___ Custodial Parent (if applicable): ___________________________________________________ SCCA 435 (12/2009) American LegalNet, Inc. www.FormsWorkFlow.com Signature of Affiant Year: ________ ON-GOING SUPPORT (A) Amount Due (B) Amount Paid (C) Balance (A) - (B) =(C) COURT ORDERED PAYMENT OF MEDICAL AND/OR DENTAL BILLS (D) Amount Due (E) Amount Paid (F) Balance (D) - (E) = (F) Month January February March April May June July August September October November December TOTALS Year: ________ ON-GOING SUPPORT (A) Amount Due (B) Amount Paid (C) Balance (A) - (B) =(C) COURT ORDERED PAYMENT OF MEDICAL AND/OR DENTAL BILLS (D) Amount Due (E) Amount Paid (F) Balance (D) - (E) = (F) Month January February March April May June July August September October November December TOTALS Page # ______ of an attachment containing ______ # of pages. _________ (INITIALS OF AFFIANT) SCCA 435 (12/2009) American LegalNet, Inc. www.FormsWorkFlow.com