Acknowledgment Of Receipt Of Payment Of Child Support - Order {2F-P-503}

Name: Address: Telephone No. IN THE FAMILY COURT OF THE SECOND CIRCUIT STATE OF HAWAII ) FC- NO. ))ACKNOWLEDGMENT OF RECEIPT Petitioner/Plaintiff, ) OF PAYMENT OF CHILD SUPPORT; ) ORDER vs. ))))) Respondent/Defendant. ) ACKNOWLEDGMENT OF RECEIPT OF PAYMENT OF CHILD SUPPORT COMES NOW , and hereby states that on (date), I received child support in the amount of $ directly from and not through the Child Support Enforcement Agency (CSEA). By this acknowledgment I wish to have CSEA credit the payor-obligor for this amount against the outstanding obligation. I understand that any monies received by me will not be credited by CSEA against any current or past due child support owed by the payor to the Department of Human Services. American LegalNet, Inc. www.FormsWorkFlow.com My Social Security Number (last four) is XXX-XX-. The payor/obligor222s Social Security Number (last four) is XXX-XX-. Our CSEA or APB Case No., if we have one, is . The name(s) and year of birth of our child(ren) to which the current obligation is owed is/are: Child Initials Birth Year DATED: Wailuku, Hawaii, Signature Printed Name APPROVED AND SO ORDERED: Judge of the above-entitled Court PLEASE NOTE: American LegalNet, Inc. www.FormsWorkFlow.com