Free jdf1807 - Colorado

q District Court
_________________________________________ County, Colorado Court Address: In Re: Petitioner:

Respondent/Co-Petitioner: COURT USE ONLY Attorney or Party Without Attorney (Name and Address): Case Number:

Phone Number: FAX Number:

E-mail: Atty. Reg.#: AFFIDAVIT OF ARREARS

Division

Courtroom

I, ________________________________________________________________, declare under oath that: 1. The type of support ordered is

q child support q maintenance q other (specify):
2. 3. The amount of support ordered to be paid each month is $ The support payment has not been timely made and: (check applicable statement) .

q a. (if payments were to be made into the court registry or Family Support Registry)
The full payment was not received by the registry on or before the due date of ___________________________.

q b. (if payments were to be made to the Obligee directly)
I did not receive the full payment on or before the due date of _________________________. 4. If any modifications have been made to the Support Order complete the following: a. b. 5. Effective date of any modification: ________________________ Amount of any modification: $____________________________ $__________ $__________ $__________ $__________ + interest at ____% (12% unless otherwise agreed)

Total child support due (________ payments due x $_____________) a. b. c. Total amount of child support paid One twenty-fourth of Line 5b Total principal of amount of child support due

JDF 1807

R7/00

AFFIDAVIT OF ARREARS

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6.

Total maintenance due (______ payments due x $______________) a. b. c. Total amount of maintenance paid One twenty-fourth of Line 6b $__________ $__________ $__________ + interest at ____% (8% unless otherwise agreed) Total principal amount of maintenance due

Attach a copy of the payment record maintained by the Family Support Registry, if payment is ordered through the Family Support Registry, or detail period(s) on a separate sheet of paper of the time when the arrears accrued for child support and for maintenance. I declare under penalty of perjury that I have read this affidavit and the statements contained are true to the best of my knowledge. Date:
Obligee

My Commission expires :
Notary Public/Deputy Clerk

CERTIFICATE OF SERVICE

I certify that on _________________________ (date) I sent the original and one copy of this Affidavit of Arrears to the COURT, by United States Mail, first class postage prepaid, addressed as follows:

AND I certify that I sent a copy of the Affidavit of Arrears to the Obligor by United States Mail, first class postage prepaid addressed as follows:

Signature

JDF 1807

R7/00

AFFIDAVIT OF ARREARS

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