Affidavit For Termination Of Child Support And Modification Form Page 2
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2NOTICE TO PARENT RECEIVING SUPPORT
If you agree with 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 motion to modify, will schedule
an evidentiary hearing, and may require payment of a deposit as security for costs.
Your failure to file an Acknowledgment or Answer with the Court within 30 days of your receipt of this
Affidavit will result in entry by default of a judgment terminating the obligation to pay support for the child.
Please mail your answer to:
Jackson County Circuit Court
Jackson County Circuit Court
Civil Records Department/Domestic Relations
Civil Records Department/Domestic Relations
th
rd
nd
415 E. 12
Street, 3
Floor
308 W. Kansas, 2
Floor
Kansas City, MO 64106
Independence, MO 64050
You must also mail a copy of your Answer/Acknowledgment to the party who filed the Affidavit.
______________________________________________________________________________________________
CERTIFICATE OF MAILING OF PARENT RECEIVING SUPPORT
If Affidavit is filed by Parent Receiving Support then a copy of the affidavit must be mailed to the other side
and this certificate must be completed.
I certify that on the ___________ day of ____________________________, I mailed a copy of this Affidavit to the Parent
Paying Support at the following address: ________________________________________________________________
_______________________________________________________________________________________________
SHERIFF’S OR SERVER’S RETURN
I certify that I served a copy of this Affidavit in______________________________________________ County, Missouri:
PERSONAL SERVICE
(1)
By delivering a copy of the summons and a copy of the affidavit to the parent receiving support
____________________________________________________________________________________
MEMBER OF FAMILY
(2)
By leaving a copy of the Affidavit at the dwelling place or usual place of abode of the parent receiving
support with _________________________________________________________________________
a person of his or her family over the age of 15 years
NON-EST
(3)
By making a diligent search for and failing to find the parent receiving support ______________________
for the reason that:____________________________________________________________________.
Served at (address) ___________________________________________________________________________________________
on (date) __________________________________
at (time) ______________________ M.
By ________________________________________________________
Sheriff or Server
MUST BE SWORN BEFORE A NOTARY PUBLIC IF NOT SERVED BY AN AUTHORIZED OFFICER
Subscribed and sworn to before me on ____________________________________________________.
(Seal)
______________________________________________________________________________________
Notary Public
My Commission Expires: _____________________________________________
Once completed, a copy of this service return should be forwarded immediately to the applicable Jackson County Courthouse,
Department of Civil Records, Domestic Relations Section.
07/07
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