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Get CA DCSS 0569 2009

SUPPORT PAYMENT HISTORY The reverse of this page is your declaration of the support payment history for your case. You are asked to complete a month-by-month, year-by-year breakdown of the amounts of support that were due (ordered by the court) and the amount of each payment that was made. These figures will help determine the amount of the past due support owed, if any. You must complete a separate page (or pages) for child support, spousal support, family support, medical support, unreimburse.

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