IN THE CIRCUIT COURT IN AND FOR ESCAMBIA COUNTY, FLORIDA ___________________________________, Petitioner Case No. _____________________ Division vs. ___________________________________, Respondent. NOTICE OF SOCIAL SECURITY NUMBER I, {full legal name} ___________________________________, certify that my social security number is ______________________, as required in §61.052(7), or (10), §742.031(3), §742.032(1)-(3), and/or §742.10(1)(2), Florida Statutes. My date of birth is _____________________________. [U one only] _____ 1. This notice is being filed in a dissolution of marriage case in which the parties have no minor children in common. ____ 2. This notice is being filed in a paternity or child support case, or in a dissolution of marriage in which the parties have minor children in common. The minor child(ren)’s name(s), date(s) of birth and social security number(s) is/are: Name Birth Date Social Security Number _____________________________________ _________________ ______________________________ _____________________________________ _________________ ______________________________ _____________________________________ _________________ ______________________________ _____________________________________ _________________ ______________________________ [Attach additional pages if necessary] I understand that I am swearing or affirming under oath to the truthfulness of the claims made in this notice and that the punishment for knowingly making a false statement includes fines and/or imprisonment. DATED this ______ day of ____________________________, 20____. _________________________________________ SIGNATURE __________________________________________ Printed Name __________________________________________ Address __________________________________________ Telephone: (____) ____________________________ SWORN TO OR AFFIRMED AND SIGNED BEFORE ME THIS _____ DAY OF _______________________, 20___. __________________________________________( SEAL) NOTARY PUBLIC - STATE OF FLORIDA or ERNIE LEE MAGAHA CLERK OF THE CIRCUIT COURT By: _______________________________________ Deputy Clerk (SEAL) American LegalNet, Inc. www.FormsWorkflow.com