AFFIDAVIT OF CHILD SUPPORT ARREARS WORKSHEET

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Rev Aff Arr (3/20/03) AFFIDAVIT OF CHILD SUPPORT ARREARS WORKSHEET Court Orders Court Order Date Mo/Day/Year Name of Court $ Amount of Child Support Ordered Frequency (Weekly or Monthly)* Arrears Established by the Court (if any) $ [ ] Wk [ ] Mo $ $ [ ] Wk [ ] Mo $ $ [ ] Wk [ ] Mo $ $ [ ] Wk [ ] Mo $ $ [ ] Wk [ ] Mo $ $ [ ] Wk [ ] Mo $ * Please note if frequency is other than weekly or monthly. Payments Made/Past-Due Support Owed Year_____ # FRI DUE PAID BALANCE Year_____ # FRI DUE PAID BALANCE January January February February March March April April May May June June July July August August September September October October November November December December TOTALS TOTALS Rev Aff Arr (3/20/03) AFFIDAVIT OF CHILD SUPPORT ARREARS WORKSHEET Payments Made/Past-Due Support Owed Year_____ # FRI DUE PAID BALANCE Year_____ # FRI DUE PAID BALANCE January January February February March March April April May May June June July July August August September September October October November November December December TOTALS TOTALS Year_____ # FRI DUE PAID BALANCE Year_____ # FRI DUE PAID ... more. less.

BALANCE January January February February March March April April May May June June July July August August September September October October November November December December TOTALS TOTALS

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