IN THE COURT OF COMMON PLEAS OF LEHIGH COUNTY, PENNSYLVANIA

DOMESTIC RELATIONS SECTION

*
Plaintiff	*	Docket No:
VS	*
*	PACSES Case No:
Defendant	*
Other State ID:

REQUEST TO CREDIT ARREARS

I, request to credit the arrears in above captioned case in the amount of $ .

This credit is for:

Direct payments.

Purchases made or services performed by the Defendant on behalf of the Plaintiff and/or child(ren).

Time the child(ren) resided with the Defendant as agreed upon by parties, or addressed in a partial custody order for the following time periods:

From	to
From	to
From	to

Other:

Please sign and return this request with a copy of your photo identification. If a copy of your photo identification is not provided, this request cannot be granted.

You may not credit arrears that are owed to the Department of Human Services (DHS).

Once credit has been applied to the arrears, the amount of the credit may not be reinstated.

_________________________________	__________________

Plaintiff Signature	Date

FI-003

Stabinsky, Raymond T.

2019-01-02

Rachel A Wotring

PACSES Commonwealth of Pennsylvania