Agreement For Credit For Direct Payments

ATTENTI ON Your support payment has been court ordered to be paid through the Clerks Depository or the Florida State Disbursement Unit. The policy is that any payment made directly to you by the non-custodial parent is considered a gift. We do realize that circumstances arise when taking a payment directly is necessary. Therefore, we have attached an Agreement for Credit for Direct Payments for your signature. These forms are intended for emergency use only and are not authorization to continue accepting payments directly. Only two credits for direct payment will be accepted per case per year. Please do not ask us to make an exception to this policy. WARNING: FAILURE TO PAY THROUGH THE COURT AS DIRECTED IN YOUR COURT ORDER CAN RESULT IN ENFORCEMENT ACTION BY THE DEPOSITORY. Note: This credit is subject to approval by your case manager if you are contracted with the Child Support Enforcement division. X__________ Please initial here that you have read this notice and fully understand the policy of this office. <<<<<<<<<********>>>>>>>>>>>>> 2 IN THE CIRCUIT COURT OF THE TWEL FTH J UDICIAL CIRCUI T IN ANDFOR MANATEE COUNTY, FLORIDA CIVIL ACTION ______________________________, CASE NO: _______________________ Petitioner, vs _____________________________, Respondent, AGREEMENT FOR CREDIT FOR DIR ECT PAYMENTS I am the recipient of support payments ordered to be made by ______________________________. I hereby agree and request the Manatee County Clerk of Court, Child Support Depository, to credit the above referenced case for payments or services provided DIRECTLY to me in the following amounts: $ ______ - child support $________________ - established arrears $ ______ - alimony By so requesting, I understand that I may lose my right to enforce collection of the above amount. I also relieve the Child Support Depository of any obligation it may have with regard to the payments made directly to me. I understand this agreement will be made part of the Court file. _________________________________ P AYEE STATE OF FLORIDA COUNTY OF MANATEE Sworn to and subscribed before me this _ day of__ , 20_ by ___________ , who is personally known to me or has produced_______________________________________________ as identification. ___________________________ OR R. B. Shore Notary Public Signature Clerk of the Circuit Court ___________________________ (Notary name typed or printed) By:_____________________________ D eputy Clerk Notary Seal: FOR CHILD SUPPORT DEPOSITORY USE ONLY: Direct credit in the amount of $___________ entered on the above referenced child support case on this _____ day of ____________________, 20____. _______________________________ Depository Clerk acdp