FORM: 849 STATE OF VERMONT SUPERIOR COURT ______________ Unit Plaintiff Name DOB FAMILY DIVISION Docket No.______________ Defendant Name DOB / / v. / / STATEMENT OF CONFIDENTIAL INFORMATION 1. I am the: Plaintiff Defendant in the above action. 2. For purposes of identification, my social security number is: _______________________________________ 3. If known, the other party's social security number is: _______________________________________ 4. The social security numbers of the children involved in this case are: Name of Child Social Security # THIS INFORMATION WILL BE KEPT CONFIDENTIAL AND WILL ONLY BE RELEASED WITH YOUR CONSENT OR AS REQUIRED BY LAW TO THE OFFICE OF CHILD SUPPORT. American LegalNet, Inc. www.FormsWorkFlow.com