Petition For Credit For Direct Payment Of Child Support/alimony Page 2
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2_____________________________, Petitioner
Case Number: __________________
Division: ______________________
Vs.
DEP ACCOUNT#:______________
_____________________________, Respondent
Direct Payment of Child Support/Alimony
STATE OF FLORIDA, COUNTY OF ESCAMBIA
SWORN to and subscribed before me this
___________________________________
_______ day of ____________________, 20_____
PAYOR'S Signature
(
) Personally known to me
___________________________________
Name - typed or printed
(
) Produced Identification:___________________
___________________________________
Street Address
___________________________________(SEAL)
___________________________________
NOTARY PUBLIC - STATE OF FL
City, State, Zip Code
or
___________________________________
PAM CHILDERS
Telephone Number
Clerk of the Circuit Court
BY:________________________________(SEAL)
Deputy Clerk
If only one party has signed:
Copy Sent to _____Payor _____Payee this _______, day of ________________________, 20____.
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