Motion To Modify Child Support Forms Package Page 24
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36I certify under oath that I have given the other party a copy of this Income and Expense Statement pursuant to Missouri
Supreme Court Rule 43.01(d) by: (You MUST check at least ONE of the following four boxes)
____________________
Mailing a copy to the other party or his or her attorney on
at the following address:
(Date)
______________________________________________________________________
(Street)
_________________________
__________________
______________
(City)
(State)
(Zip)
____________________
Handing a copy to the other party or his or her attorney on
.
(Date)
Sending a copy to the other party or his or her attorney by fax to
____________________
_______________ (fax number) on
at ____________
.
(Date)
(Time)
(To be used only by written consent of the party filed with the court) Sending a copy via electronic mail to the other
party or his or her attorney at ________________________________________________________
on
(Email Address)
____________________
.
(Date)
Instructions: The following information MUST be filled in before a notary public. This Income and Expense Statement is required to be verified before a notary
public. The “Affiant” is the person that is completing this document.
COUNTY OF ________________
)
) ss.
STATE OF _________________
)
Affiant, of lawful age, being duly sworn on his or her oath, states that he or she is the affiant named herein and
that the facts stated in this Income and Expense Statement are true according to his or her best knowledge
and belief.
►__________________________________
_______________________________________
Affiant – SIGN HERE
Affiant – PRINT YOUR NAME HERE
____________________
Subscribed and sworn to on
.
Sign here in front of
__________________________________
a Notary Public
Notary Public
My Commission Expires: _________________________
Statement of Income and Expenses - Page 3 of 3
Form CAFC150-7/1/2010
This form is available for free at
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