Child Support Enforcement CS-ES52i R. 06/10 Parent Information Other Parent Information - a separate Parent Information form is required for the other parent(s) of each child who needs service. Other Parent’s Full Name (First, Middle, Last, Suffix): Are you seeking child support from this Social Security Number: parent? Date of Birth: Sex: __ __ __ -__ __ -__ __ __ __ Female Male Home Phone (include area code): Current City: State: Last Known Mailing Zip code: Residential Driver’s License No.: Employer: No ______/______/________ Cell Phone (include area code): Work Phone (include area code): Address: Yes Country: Issuing State: Employer’s Address: Employer’s City: Employer’s State: Employer’s Zip: Is health care available from this employer? Yes No Unknown Place of Birth (City/County/State/Country): Other Names Known By: ____________________________________ ____________________________ Alias Nickname ____________________________________ ____________________________ Alias Nickname Weight: Race: Height: Asian Black Hair Color: Eye Color: Hispanic White Other Identifying Features: None Piercings Gold Teeth Scars Mustache Beard Glasses Tattoos Pigtails Ponytail Bald Other: __________________________________________________ Native American Other List this parent’s children (or possible children) included in this application. Please complete an additional Child Information form (CS-ES51ACI) for each child listed. Child’s Full Name (First, Middle, Last, Suffix) Child’s This Parent’s Relationship to the Child Social Security Number (Mother, Father or Possible Father) _________________________________________________________ ___________________ _____________________________ _________________________________________________________ ___________________ _____________________________ _________________________________________________________ ___________________ _____________________________ _________________________________________________________ ___________________ _____________________________ _________________________________________________________ ___________________ _____________________________ _________________________________________________________ ___________________ _____________________________ _________________________________________________________ ___________________ _____________________________ _________________________________________________________ ___________________ _____________________________ _________________________________________________________ ___________________ _____________________________ Page 1 of 1 American LegalNet, Inc. www.FormsWorkFlow.com