TRAVIS COUNTY DOMESTIC RELATIONS OFFICE 1010 Lavaca Street P.O. BOX 1495 AUSTIN, TEXAS 78767 (512) 854-9696 FAX (512) 854-9819 www.traviscountydro.com CUSTODIAL PARENT'S AFFIDAVIT OF DIRECT PAYMENTS CAUSE NUMBER______________________ DRO ACCOUNT NUMBER_______________________ I____________________________________, the custodial parent: certify that either: I have not received any support payments (in any form) directly from __________________________________, the Non-custodial parent, including payments from a Trust Fund Escrow Account or Military Allotment, and any payments I received were send to me from either the Domestic Relations Office or the State Disbursement Unit (SDU) or the list of support payments provided below (including all dates and amounts) is a correct list of payments I received directly from_________________________________, the non-custodial parent, and that these payments were not sent to me from either the Domestic Relations Office or the State Disbursement Unit SDU). I authorize and request the Domestic Relations Office to disclose this document in its entirety, to _______________________________,(the person from Whom the support payments were received) and file it with the court. I certify that there is no court order in effect that prohibits the release of this information, and that this information will be used only for Child Support purposes. Date Amount Date Amount Date Amount Date Amount TOTAL OF ALL DIRECT PAYMENTS: $ ______________________ _______________________________ Custodial Parent ____________________________ Date STATE OF TEXAS SUBCRIBED AND SWORN TO BEFORE ME on this ______________day of _________________________ ___________________________________ Notary Public in and for the State of Texas American LegalNet, Inc. www.FormsWorkFlow.com