Acknowledgement Agreeing To Termination Of Child Support printable pdf download

Acknowledgement Agreeing To Termination Of Child Support

IN THE ________ JUDICIAL CIRCUIT COURT, _______________________, MISSOURI

Judge or Division:

Case Number:

MACSS Case ID:

Petitioner:

Petitioner’s Address:

SSN (last four digits):

vs.

Respondent:

Respondent’s Address:

SSN (last four digits):

(Date File Stamp)

Acknowledgment Agreeing to Termination of Child Support

NOTE: This form may be used only where a claim is made that no child remains entitled to support.

Directions:

If you are the person receiving support and you agree to termination of the obligation to pay support for the

child, you may, but are not required to, file this Acknowledgment with the Court. (See Certificate of Person Receiving

Support below.)

Upon your filing of this Acknowledgment, a judgment terminating the obligation to pay support for the child will be

entered. Your failure to file this Acknowledgment within 30 days of your receipt of the Affidavit may result in entry by

default of a judgment terminating the obligation to pay support for the child.

I, ______________________________, am receiving support for _________________________________ (name)

(hereinafter referred to as the child), whose age is _____________________. I acknowledge that the child is no longer

entitled to support and, therefore, agree to termination of the obligation of ______________________________ (name)

to pay support for the child.

The facts in this Acknowledgment are true to my best knowledge and belief and are made under penalty of perjury.

______________________________________

__________________________

Signature of Person Receiving Support

Date

Certificate of Person Receiving Support

I certify that on __________________ (date), I filed the original of this Acknowledgment with the Circuit Clerk of

_____________________________ (County/City of St. Louis), Missouri, at _____________________________________ (address)

and mailed a copy of this Acknowledgment to ______________________________________ (name), the person paying support, at

___________________________________ (address), _____________________________ (city), ________________ (state).

______________________________________

Signature of Person Receiving Support

OSCA (8-09) CS96

1 of 1

452.340 RSMo

Acknowledgement Agreeing To Termination Of Child Support