Affidavit Of Direct Payments
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Name of Person Filing:
___________________________________________
Mailing Address:
___________________________________________
City, State, and Zip Code:
___________________________________________
Daytime Phone Number:
___________________________________________
Evening Phone Number:
___________________________________________
ATLAS Number (if applicable): ___________________________________________
State Bar Number (if applicable):_________________________________________
Representing:
Self
Petitioner
Respondent
SUPERIOR COURT OF ARIZONA
MOHAVE COUNTY
Case Number:
(Name of Petitioner)
AFFIDAVIT OF DIRECT PAYMENTS
AND
(Name of Respondent)
COMES NOW _______________________________and swears that the attached foregoing account of direct
payments made by ____________________________ and received by _______________________ is true and
(Obligor’s Name)
(Obligee’s Name)
correct to the best of his/her knowledge.
Signature of Obligor:_____________________________________
Date:________________________
SUBSCRIBED AND SWORN TO before me on this___________________ day of __________________, _________
My commission Expires:__________________________
__________________________________________
Notary Public / Deputy Clerk
Signature of Obligee:_____________________________________
Date:________________________
SUBSCRIBED AND SWORN TO before me on this___________________ day of __________________, _________
My commission Expires:__________________________
__________________________________________
Notary Public / Deputy Clerk
Page 1 of 2
12/26/2006
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Parent category: Legal