Free STATE OF SOUTH CAROLINA - South Carolina

STATE OF SOUTH CAROLINA COUNTY OF

Petitioner vs.

Respondent.

) ) ) ) ) ) ) ) ) ) )

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 )
)
) ) )
) )


,

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)