Child Support Data Sheet
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Child Support Data Sheet Form. This is a Illinois form and can be use in Lake Local County.
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Tags: Child Support Data Sheet, 171-192, Illinois Local County, Lake
IN THE CIRCUIT COURT OF THE NINETEENTH JUDICIAL CIRCUIT
LAKE COUNTY, ILLINOIS
)
CASE NO. _____________________
________________________________________)
PLAINTIFF/PETITIONER)
vs.
)
)
________________________________________)
DEFENDANT/RESPONDENT)
COUNTY: _____________________
DATE: _______________________
CHILD SUPPORT DATA SHEET
OBLIGOR INFORMATION
OBLIGEE INFORMATION
Last name:
Last name:
First name:
Complete Residential Address:
Middle In.:
First name:
Complete Residential Address:
Middle In.:
Complete Mailing Address (If other than above):
Complete Mailing Address (If other than above):
Date of Birth:
Date of Birth:
Driver’s License No.:
Driver’s License No.:
*Social Security No.:
Social Security No.:
Home Phone Number: (
)
Home Phone Number: (
)
Employer(s) Name/Company:
Employer(s) Name/Company:
Employer(s) Address:
Employer(s) Address:
Employer(s) ID Number:
Employer(s) ID Number:
Work Phone Number: (
)
Work Phone Number: (
)
CHILD/CHILDREN INFORMATION
LAST
FIRST
MIDDLE
INITIAL
DATE OF
BIRTH
SOCIAL SECURITY
NUMBER
1.
2.
3.
4.
5.
(If more space is needed, attach an additional sheet.)
* If obligor is not a US citizen, so indicate and provide the obligor’s alien registration number, passport number and
home country’s social security or national health number.
Form approved by Conference of Chief Circuit Judges
171-192 Rev 04/06
Exhibit 1
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