HomeMy WebLinkAbout0396 A F F I D A V I T
STATE OF FLORIDA
COUNTY ~----sls-~S~Sr~l--
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BT~FORB N8, the undatsignsd authority, personally appsased W~,~,li~-Js---_--•-
Williams the Father~li~/xaeponeible Parent,
who after being duly sworn, dapose• and •ays.
1. That the attached paper(s) have been signed freely and voluntarily and
are true and-correct;
----Acknowledgement of Pagesity
R Support Agreement
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Acknowledgement of Assignment of Rights to Support (DFS-7801:)
Other: Wage assignment
2. That he/aLe has agreed to pay S 50.00 per-month plus $2.00
on arrears '
Statutory fee as and for child support, to be paid thoough the Registry of
this court and Lhereupon the Clerk will forward said child support funds
to the Department of Health and Rehabilitative Services, 1317 Winewood Blvd.,
Tallahassee, Florida, 37.301.
3. That he/sit! understands that it is necessary for the Petitioner,
Department of Health and Rehabilitative Services of the State of Florid,
to file in the Circuit .Court, a Complaint for Determination of Paternity
and Child Support and/or Petition for child support.
4. That he/ate submits to the-jurisdiction of said court.
~ 5. That h7e/sL~ knowingly waives service of process and further notice {
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of all hearings in the matter, and his/her right to counsel.
6. that he/aiw acknowledges the hearing to be held before the Honorable
I
one of the Judges of the Circuit Court
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on the day of 19 at o'clock A. M. ~
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7. That he/she has no objections and apedifically requests the relief
request~:d in this cause.
Sworn to and -su~~ii;es~ ,before ure on this
1 l i. ~ 1
a~ ~ ~ Ida of ~ ~~y~~~ 19~
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my commission azpiras:
Notary pab6c. Stile~el ftaida at ~
My Com+rissioe Eipires My 15;1983
f..bd N ~••~w• fw a Cariy c..w+er
BonKJJ~ PAGE ei~U
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