Affidavit For Termination Of Child Support (Page 2 of 3) in pdf

Notice to Parent Receiving Support

If you agree with the statements in this Affidavit and agree to termination of the obligation to pay support for the child, you

may, but are not required to, file an Acknowledgement with the Court. Upon your filing of an Acknowledgement, a judgment

terminating the obligation to pay support for the child will be entered.

If you disagree with the statements in this Affidavit and object to termination of the obligation to pay support for the child,

you must file with the Court an Answer which states the reasons the obligation to pay support for the child should continue.

Upon your filing of an Answer, the Court will treat this Affidavit as a request for hearing.

Your failure to file an Acknowledgment or Answer with the Court within 30 days of your receipt of this Affidavit may

result in entry by default of a judgment terminating the obligation to pay support for the child.

Certificate of Service of Parent Receiving Support

I certify that on ___________________________ (date), I filed the original Affidavit with the Circuit Clerk of

__________________________ (County/City of St. Louis), Missouri at __________________________________ (address),

and mailed a copy to ________________________________________________ (name), the parent paying support, at

__________________________________________ (address), _____________________________ (city), ___________ (state).

___________________________________________

Signature of Parent Receiving Support

Sheriff’s or Server’s Return

I certify that I served this Affidavit at ________________________________________________________________ (address)

in _________________________ (County/City of St. Louis), ________________ (state), on ___________________ (date), at

______________ (time), by:

(Check one)

delivering a copy of the Affidavit and Answer and Acknowledgement forms to _______________________ (name);

leaving a copy of the Affidavit and Answer and Acknowledgement forms at the dwelling place or usual abode of

_________________________________________ (name), with __________________________ (name), a person of

_________________________________________ (name)’s family over the age of 15 years.

other (describe) ________________________________________________________________________________

_____________________________________________________

_______________________________________________________________

Printed Name of Sheriff or Server

Sheriff or Server

Must be sworn before a notary public if not served by an authorized officer

(Seal)

Subscribed and sworn to before me on ___________________________ (date).

My commission expires: __________________

___________________________________

Date

Notary Public

Sheriff’s Fee (if applicable)

Service Fee

Sheriff’s Deputy Salary

Supplemental Surcharge $

10.00

Mileage

(______ miles @ $.______ per mile)

Total

_______________________________________________

Sheriff or Server

OSCA (0 -1 ) CS95

2 of 3

52.340

RSMo

Affidavit For Termination Of Child Support Page 2

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