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Child Support Agreement on Consent for Waiver of Arrears

CSMS: ________________
Date: ________________

I, ______________________, mother of ___________________, do voluntarily and


willingly waive the child support arrears due to me by my child/ren’s father,
________________________, for the amount of $_________________ or whatever is
the current outstanding balance due to me. I am fully aware of my right to collect these
arrears and understand the consequences of this waiver.

Thank you very much for your cooperation in this matter. If you require any further
information, please contact me at ____________________.

Sincerely,

_________________________

Sworn to before me this ______


day of ________, 20___

___________________________________
Notary Public

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