STATE OF SOUTH CAROLINA	)	IN THE FAMILY COURT
)	JUDICIAL CIRCUIT
COUNTY OF	)
)
)
)	AFFIDAVIT OF ARREARS
Plaintiff,	)
vs.	)
)
)
Defendant.	)	Docket No.

DIRECTIONS

1.	Calculate each month separately. Do NOT keep a running balance.

2.	The total DUE minus the total PAID equals the total BALANCE.

3.	The "amount due and owing" in the affidavit is calculated by adding the balance columns for each year.

4. If your support order requires that the Plaintiff/Defendant pay medical and/or dental bills, you may include these on your Affidavit. Calculate these separately from your ongoing support. Attach copies of these bills, if you have them, to your Affidavit to support your claim.

5.	Attach a TRUE or CERTIFIED copy of any pay records that a court or other collection entity has maintained on payments made pursuant to the support order.

6.	The signature of the affiant must be notarized.

7.	Attach additional sheets as necessary.

AFFIDAVIT

, who being duly sworn, states under oath that the following attachment, incorporated herein by reference, is a schedule of support payments and balances due her/him, as obligee, based on the order entered in the State of , dated , requiring , the obligor, to make support payments in the amount of $ per .

That the amount of $ is due and owing as arrears from the period beginning and ending .

Sworn to before me this
______ day of _______________, 20___
Notary Public for South Carolina
Signature of Affiant
My Commission expires ___________, 20___

Custodial Parent (if applicable):

YEAR

ON-GOING SUPPORT	COURT ORDERED PAYMENT OF

MEDICAL AND/OR DENTAL BILLS
Month	(A)

Amount Due	(B)

Amount Paid	(C)

Balance

(A) – (B) = (C)	(D)

Amount Due	(E)

Amount Paid	(F)

Balance

(D) – (E) = (F)
January
February
March
April
May
June
July
August
September
October
November
December
TOTALS

YEAR

ON-GOING SUPPORT	COURT ORDERED PAYMENT OF

MEDICAL AND/OR DENTAL BILLS
Month	(A)

Amount Due	(B)

Amount Paid	(C)

Balance

(A) – (B) = (C)	(D)

Amount Due	(E)

Amount Paid	(F)

Balance

(D) – (E) = (F)
January
February
March
April
May
June
July
August
September
October
November
December
TOTALS
Page # of an attachment containing # of pages. _________ (INITIALS OF AFFIANT)

SCCA 435 (12/2009)

FFOR201 - Affidavit of Arrears

2010-03-03