S T A T E In re the O F Marriage W I S C O N S I N C I R C U I T C O U R T FAMILY COURT BRANCH K E N O S H A C O U N T Y Paternity of ______: (initials) Affidavit Regarding Arrears ____________________________________, Petitioner / Joint Petitioner and ____________________________________, Respondent / Joint Petitioner Case # ____________________ STATE OF WISCONSIN is NOT a party STATE OF WISCONSIN IS a party STATE OF WISCONSIN) )SS KENOSHA COUNTY ) _____________, being first duly sworn under oath states as follows: (Name of party making request) 1. I am the Petitioner Respondent Joint Petitioner in this action. 2. The judgment or last court order filed on _______________ ______, __ __ __ __ (Month) (Day) (Year) required _____________________________ to make support or other payments through income (Name of Payer) withholding and/or through the Wisconsin Support Collections Trust Fund. 3. (Mark only A or B with an X.) A. Direct Payments I have made support or other payments directly to the other party. I am requesting the court to change the arrears balances on the KIDS computer system to give credit for the direct payments. The following arrears should be reduced by the amount of the direct payments: (Write the amount of the direct payment in the blank.) Child support direct payment of Maintenance direct payment of Family support direct payment of Other direct payment $_______________ $_______________ $_______________ $_______________ (Specify type of payment)____________ B. Arrears Balances I am requesting that the court change the balances of the arrears as follows: Child support arrears set to balance of Child support interest arrears set to balance of Maintenance arrears set to balance of Family support arrears set to balance of Other arrears set to balance of $_______________ $_______________ $_______________ $_______________ $_______________ (Specify type of arrears) _________________________________ 5007F-Divorce – Forms Page 1 of 2 Affidavit Regarding Arrears WCCSH Rev. 5/21/02 American LegalNet, Inc. www.USCourtForms.com I am making this request because:_________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________ 4. Arrears Payments I am requesting the payer to start paying the arrears beginning on ____________ ____, 20__ __ (Month) (Day) (Year) in the monthly amount of $ _________________ until further order of the court. ______________________________________________ Signature of party making request Subscribed and sworn to before me , 20 . this day of ___________________________ Notary Public, State of Wisconsin My Commission Expires:_____________ 5007F-Divorce – Forms Page 2 of 2 Affidavit Regarding Arrears WCCSH Rev. 5/21/02 American LegalNet, Inc. www.USCourtForms.com