Confidential Information Form (INFO)

County:

Cause Number:

Do not file in a

Court Clerk:  This is a Restricted Access Document

public access file.

 Divorce/Separation/Invalidity/Nonparental Custody/Paternity/Modifications   Sexual Assault    Other

 Domestic Violence   Antiharassment   Information Change (Check if you are updating information)

 A restraining order or protection order is in effect protecting  the petitioner  the respondent  the children.

 The health, safety, or liberty of a party or child would be jeopardized by disclosure of address information because:                                                                                                                      

The following information about the parties is required in all cases:

(Use the Addendum To Confidential Information Form to list additional parties or children)

Petitioner Information

Type or Print Only

Respondent Information

Name (Last, First, Middle)

Name (Last, First, Middle)

Race

Sex

Birthdate

Race

Sex

Birthdate

Driver’s Lic. or Identicard (# and State)

Driver’s Lic. or Identicard (# and State), (or, if unavailable, residential address)

Mailing Address (P.O. Box/Street, City, State, Zip)

Mailing Address (P.O. Box/Street, City, State, Zip)

Relationship to Child(ren)

Relationship to Child(ren)

The following information is required if there are children involved in the proceeding. (Soc. Sec. No. is not required for petitions in protection order cases (Domestic Violence/Antiharassment/Sexual Assault).)

1) Child's Name (Last, First, Middle)

Child's Race/Sex/Birthdate

Child's Soc. Sec. No. (If required)

Child's Present Address or Whereabouts

2) Child's Name (Last, First, Middle)

Child's Race/Sex/Birthdate

Child's Soc. Sec. No. (If required)

Child's Present Address or Whereabouts

List the names and present addresses of the persons with whom the child(ren) lived during the last five years:

List the names and present addresses of any person besides you and the respondent who has physical custody of, or claims rights of custody or visitation with, the child(ren):

Except for petitions in protection order cases (Domestic Violence/Antiharassment/
Sexual Assault), the following information is required:

Petitioner's Information

Respondent's Information

Soc. Sec. No.:

Soc. Sec. No.:

Residential Address (Street, City, State, Zip)

Residential Address (Street, City, State, Zip)

Telephone No.: (       )

Telephone No.: (        )

Employer:

Employer:

Empl. Address:

Empl. Address:

Empl. Phone No.: (       )

Empl. Phone No.: (       )

For Nonparental Custody Petitions only, list other Adults in Petitioner(s) household (Name/DOB):