IN THE FAMILY DIVISION OF THE SECOND JUDICIAL DISTRICT COURT OF THE STATE OF NEVADA IN AND FOR THE COUNTY OF WASHOE 1 2 3 4 5 6 7 8 9 CONFIDENTIAL FAMILY COURT INFORMATION SHEET _______________________________________, Plaintiff/Petitioner, Case No. ____________________ vs. Dept. No. ________ _______________________________________, Defendant/Respondent. Name: _____________________________________ Name: ____________________________________ Social Security #: ____________________________ Social Security #: ___________________________ Date of Birth: _______________________________ Date of Birth: ______________________________ IF THIS CASE INVOLVES CHILDREN, PLEASE COMPLETE THE FOLLOWING: 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 Residential Address: ___________________________________________ Residential Address: ________________________________________ Mailing Address: ___________________________________________ City, State, Zip: _____________________________ _ Mailing Address: _________________________________________ City, State, Zip: ____________________________ Telephone #: _________________________________ Are you employed? YES [ ] NO [ ] Name of Employer: ____________________________________________ Business Address: ____________________________________________ City, State, Zip: _______________________________ Telephone #: __________________________________ Driver’s License #: _____________________________ Date of Birth: _________________________________ Ethnicity: [ ] White (Not Hispanic) [ ] African-American [ ] Hispanic [ ] Asian or Pacific Islander [ ] Native American/Alaskan Native [ ] Other Telephone #: ______________________________ Are you employed? YES [ ] NO [ ] Name of Employer: ______________________________________ Business Address: ______________________________________ City, State, Zip: _________________________ Telephone #: ___________________________ Driver’s License #: ______________________ Date of Birth: ___________________________ Ethnicity: [ ] White (Not Hispanic) [ ] African-American [ ] Hispanic [ ] Asian or Pacific Islander [ ] Native American/Alaskan Native [ ] Other CHILDREN INVOLVED IN THIS CASE Name: ___________________________________ SSN: _______________________ DOB: ____________ Name: ___________________________________ SSN: _______________________ DOB: ____________ Name: ___________________________________ SSN: _______________________ DOB: ____________ Name: ___________________________________ SSN: _______________________ DOB: ____________ Name: ___________________________________ SSN: _______________________ DOB: ____________ If there are more than five children, list their names on a separate sheet of paper and attach. Does this case involve family violence: [ ] Yes Are you requesting Child Support Enforcement Services from the District Attorney’s Office (IV-D) Services? [ ] Yes Court Personnel Only: [ ] Custodial Parent [ [ [ ] No ] No ] Non-Custodial Parent This document contains the social security number of a person as required by NRS 123.130, NRS 125, 230, and NRS 125B.055 American LegalNet, Inc. www.FormsWorkFlow.com