Person Filing:
Address (if not protected):
City, State, Zip Code:
Telephone:
Email Address:
ATLAS Number:
Lawyer’s Bar Number:
Representing Self, without a Lawyer or Attorney for Petitioner OR Respondent
SUPERIOR COURT OF ARIZONA
IN MARICOPA COUNTY
Case No. _____________________________
Petitioner
ATLAS No.
Respondent
AFFIDAVIT OF DIRECT PAYMENTS
YEAR
YEAR
YEAR
YEAR
(Insert year)
January
$
$
$
$
February
$
$
$
$
March $ $ $ $
April $ $ $ $
May $ $ $ $
June $ $ $ $
July $ $ $ $
August $ $ $ $
September $ $ $ $
October $ $ $ $
November
$
$
$
$
December $ $ $ $
By signing this document I state under penalty of perjury that I made the following payments directly to
the person ordered to receive the payments or I received the following payments directly from the person
ordered to make the payments. These payments were not made through the Support Payment
Clearinghouse or the Clerk of the Court.
SIGNATURES
Signature of Person Receiving Payments and/or Signature of Person Making Payments
Printed Name of Person Receiving Payments Printed Name of Person Making Payments
STATE OF
COUNTY OF
Subscribed and sworn to or affirmed before me this:
(date)
By .
Deputy Clerk or Notary Public
(notary seal)
STATE OF
COUNTY OF
Subscribed and sworn to or affirmed before me this:
(date)
By .
Deputy Clerk or Notary Public
(notary seal)
For Clerk’s Use Only
© Superior Court of Arizona in Maricopa County Page 1 of 1 DRMW32f 021618
ALL RIGHTS RESERVED Use most current version
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