PLAINTIFF/PETITIONER COUNTY_______________ vs. ___________________________ DEFENDANT/RESPONDENT CHILD SUPPORT DATA SHEET OBLIGOR INFORMATION DATE__________________ 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: ( ) Employer(s) Name/Company: Home Phone Number: ( ) 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 Exhibit 1 Revised 4/28/06 Case No. American LegalNet, Inc. www.USCourtForms.com