American LegalNet, Inc. www.FormsWorkFlow.com American LegalNet, Inc. www.FormsWorkFlow.com American LegalNet, Inc. www.FormsWorkFlow.com American LegalNet, Inc. www.FormsWorkFlow.com Case No. _______________________ CHILD SUPPORT DATA SHEET OBLIGOR INFORMATION Last Name: First Name: Complete Residential Address: Last Name: First Name: Complete Residential Address: OBLIGEE INFORMATION Complete Mailing Address:(If other than above) Complete Mailing Address:(If other than above) Date of Birth: Driver's License No.: *Social Security No.: Home Phone No.: ( ) Employer(s) Name/Company: Date of Birth: Driver's License No.: *Social Security No.: Home Phone No.: ( ) Employer(s) Name/Company: Employer(s) Address: Employer(s) Address: Employer(s) ID No.: Work Phone No.: ( LAST Employer(s) ID No.: ) FIRST Work Phone No.: ( ) SOCIAL SECURITY NO. CHILD/CHILDREN INFORMATION MIDDLE INITIAL DATE OF BIRTH (If more space is needed, please attach an additional sheet) REVIEWED AND APPROVED BY:_________________________________ _________________ Clerk Family Division Date * If obligor/oblige is not a US Citizen, so indicate and provide the obligor's/obligee's alien registration number, passport number and home county's Social Security or national Health Number. Rev. 3/13 Page 5 of 5 Form Approved By conference of Chief Circuit Judges Form CS4-5 American LegalNet, Inc. www.FormsWorkFlow.com