Affidavit Of Arrears Page 2
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1
2COURT ORDERED PAYMENT OF
Year:
MEDICAL AND/OR DENTAL
________
ON-GOING SUPPORT
BILLS
(A)
(B)
(C)
(D)
(E)
(F)
Month
Amount
Amount
Balance
Amount
Amount
Balance
Due
Paid
(A) - (B) =(C)
Due
Paid
(D) - (E) = (F)
January
February
March
April
May
June
July
August
September
October
November
December
TOTALS
COURT ORDERED PAYMENT OF
Year:
MEDICAL AND/OR DENTAL
________
ON-GOING SUPPORT
BILLS
(A)
(B)
(C)
(D)
(E)
(F)
Month
Amount
Amount
Balance
Amount
Amount
Balance
Due
Paid
(A) - (B) =(C)
Due
Paid
(D) - (E) = (F)
January
February
March
April
May
June
July
August
September
October
November
December
TOTALS
Page # ______ of an attachment containing ______ # of pages. _________ (INITIALS OF AFFIANT)
SCCA 435 (12/2009)
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