Declaration Of Support Payments

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STATE OF WASHINGTON
DEPARTMENT OF SOCIAL AND HEALTH SERVICES
DIVISION OF CHILD SUPPORT (DCS)
Declaration of Support Payments
List the child support you received directly from the noncustodial parent from
to
for the child(ren) listed below:
Do not include payments you received from the Division of Child Support. Page 2 has space for five additional years if
needed. Attach additional pages if necessary.
NOTICE:
You must complete the Declaration section on page 2.
NONCUSTODIAL PARENT'S FULL NAME
CUSTODIAL PARENT'S NAME
CASE NUMBER
Year
January
February
March
April
May
June
July
August
September
October
November
December
Total
DECLARATION OF SUPPORT PAYMENTS
Page 1
DSHS 18-433 (REV. 03/2012)

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