Child Support Verification Form Page 2
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2SECTION II– COMPLETED BY ABSENT PARENT(S)
(Choose the selection that applies to you)
o I do not pay child support. I have not paid child support since: ___________________________________________
o I consistently pay child support in the amount of ___________ per:
o week
o bi-week
o month
o I pay child support that varies from week to week. In the past six weeks, I have paid the following
amounts:
Date: ___________ Amount Paid: _____________________ Date: ____________ Amount Paid: _______________________
Date: ___________ Amount Paid: _____________________ Date: ____________ Amount Paid: _______________________
Date: ___________ Amount Paid: _____________________ Date: ____________ Amount Paid: _______________________
____________________________________________________
____________________________________
Signature of Absentee Parent
Date
____________________________________________________
____________________________________
Address
Phone
Page 2 of 2
Child Support Verification – Rev. 9.22.17 jg
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