Child Support StatementFill out the online application below or download and print the Child Support Statement PDF"*" indicates required fieldsName of person receiving child support:* First Last This field is hidden when viewing the formChild support amount:*Child support amount:*Name of person paying child support:*This is not a court ordered amount, the money is paid directly to me and it is not deposited into a bank account.Certify Statement* I certify that the information contained above is complete and accurate to the best of my knowledge. I understand that I am electronically signing this statement under penalty of prosecution if I knowingly give false information to receive assistance for which I am not eligible. By checking this box and typing my name below, I am electronically signing this form.Signature*Date*DayDay12345678910111213141516171819202122232425262728293031MonthMonth123456789101112YearYear20262025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920CAPTCHACommentsThis field is for validation purposes and should be left unchanged.