CSS - Affidavit of Arrears / Direct Payments

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Jefferson County Child Support Services

AFFIDAVIT OF ARREARS / DIRECT PAYMENTS
Payment History for Noncustodial Parent (NCP) (starting with most recent month)
NCP’s (Non-Custodial Party) Full Name*
Complete the below for any payments made directly from the NCP. Please DO NOT include any payments made through the FSR (Family Support Registry).
Year

Jefferson County Child Support Services will enforce your most recent monthly child support order. If you wish to pursue past due child support, you must attach the following documents:
- ALL Child Support Orders, including temporary and modified orders
- This month by month record of payments you received directly from non custodial parent. Do not include payments sent to you from the FSR
- One certified copy if the order was issued outside Colorado
Either either of the following statements are true, please select below

I have never received any payments directly from the non custodial parentNo arrears are owed to me through
I declare under penalty of perjury under the law of Colorado that the foregoing Affidavit of Arrears/Direct Payments is true and correct.
Name of Applicant*
Email*
example@example.com
Signature*

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Location where this document was signed*
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Jefferson County Child Support Services