STATE OF SOUTH CAROLINA COUNTY OF
Petitioner vs.
Respondent.
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IN THE FAMILY COURT JUDICIAL CIRCUIT VERIFIED STATEMENT OF FACTS FOR REGISTRATION OF A FOREIGN SUPPORT ORDER UNDER UIFSA FILE NO.
Personally appeared before me, the undersigned attesting officer, , who being first sworn, deposes and says that the facts contained in this statement are true and correct, of his/her own knowledge, except those matters stated to be alleged on information and belief, and those matters (s)he believes to be true. 1. I reside at 2. is the respondent and that his last known place of residence or . post office address is:
3. The respondent was ordered to make support payments of $ per child support, and $ per spousal support, commencing ,2 pursuant to a support order of the State of , a certified copy of which is attached hereto and made a part of this petition, for the support of the following dependents:
NAME
AGE
D.O.B.
RELATIONSHIP
4. As of
,2
,$
in child support and $
spousal
support
remains unpaid. A pay record affidavit is attached hereto and made a part of this petition. 5. Respondent owns the following property which is available upon Execution: Description Location
6. This order has been registered in the following state (s): Sworn to and Subscribed before me this day of )
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,
2
Notary Public for South Carolina My Commission expires
ATTACH COMPLETED AFFIDAVIT OF ARREARS (SCCA/435a and 435b); CERTIFIED COPIES OF SUPPORT ORDER
SCCA/450 (9/1988)