STATE OF ALASKA CHILD SUPPORT SERVICES DIVISION Case No: Child: PATERNITY INFORMATION LOCATE SHEET We need more information to help establish paternity for your child. Please give us information about the person that you think is most likely to be the father. This information is important to locate the correct person. His full legal name (no nicknames):__________________________________________________ First Middle Last Any other names he may have used:_________________________________________________ Social Security Number: ____________________Date of Birth or Approx. Age:_______________ Physical description:___________________________________________________________________________ Height Weight City City Hair Color Eye Color State State Race Scars/Marks Zip Zip Mailing address: ________________________________________________________________________ Residence address: _____________________________________________________________ Work telephone number: ___________________Home number:__________________________ Did the noncustodial parent ever live or work in Alaska? No Yes When?______________ No If Place of birth: ______________Is the absent parent a citizen of the United States? Yes no, what is his country of citizenship? _________________When did he last live there?_______ His usual occupation:_____________________________________________________________ Name of his current employer:_____________________________________________________ Month, date(s), and year of your sexual relationship with this man: From: _________To:________ Name any other men that you had sexual intercourse with around the time you became pregnant (30 days before or 30 days after the child was conceived). Attach additional pages if necessary. 1) Full Name: __________________________________________________________________ First City Middle State Last Zip Address: ___________________________________________________________________ Social Security Number:____________ Date and Place of Birth: _______________Age:_____ Physical description: __________________________________________________________ Height Weight Hair Color Eye Color Race Dates of sexual relations: From _____________________To __________________________ Why do you think that this man is not the father? ____________________________________ PLEASE COMPLETE AND SIGN THE BACK OF THIS PAGE 04-1423A (Rev 08/15/11) MAT-SU: (907) 357-3550 SOUTHEAST: (907) 465-5887 TOLL FREE (In-state, outside Anchorage): (800) 478-3300 ANCHORAGE: (907) 269-6900 FAX: (907)787-3220 FAIRBANKS: (907) 451-2830 TDD machine only: (907) 269-6894 / TDD machine only, toll free (In-state, outside Anchorage): (800) 370-6894 American LegalNet, Inc. www.FormsWorkFlow.com 2) Full Name:__________________________________________________________________ First City Middle State Zip Last Address:____________________________________________________________________ Date and Place of Birth:___________________________________ Approximate Age:______ Physical description: __________________________________________________________ Height Weight Hair Color Eye Color Race Social Security Number:________________________________________________________ Dates of sexual relations: From ________________________ To______________________ Why do you think that this man is not the father? ____________________________________ ___________________________________________________________________________ If you do not know the father of your child, explain the circumstances when you became pregnant______________________________________________________________________ _____________________________________________________________________________ Information about the child: Name: Male Female Conception date___________________ Social Security Number_______________________ Date of Birth: _______________________Place of Birth: ____________________________ Have there been any legal actions for this child (such as child support orders, adoption, children's proceedings, paternity cases, divorce decree, etc.)? If so, what action, where, and when? Attach copies of legal documents.________________________________________________________ Is a father named on the child's birth certificate? Did the father sign an affidavit of paternity? No Yes No City State Yes Place:________________________ No. Yes. Were you married when the child was conceived or born? Husband's name___________________________ Social Security Number__________________ Your Work telephone number_________________ Home telephone number: ________________ Address:_______________________________________________________________________ City State Zip Social Security Number________________________ Date of Birth: _______________________ Your Employer__________________________________________________________________ Address __________________________________ City State Zip Code ________________________________ ________________________ Your name (PLEASE PRINT) Signature Date THANK YOU FOR PROVIDING THIS INFORMATION 04-1423A (Rev 08/15/11) MAT-SU: (907) 357-3550 TOLL FREE (In-state, outside Anchorage): (800) 478-3300 SOUTHEAST: (907) 465-5887 ANCHORAGE: (907) 269-6900 FAX: (907) 787-3220 FAIRBANKS: (907) 451-2830 TDD machine only: (907) 269-6894 / TDD machine only, toll free (In-state, outside Anchorage): (800) 370-6894 American LegalNet, Inc. www.FormsWorkFlow.com