CC-230 _______________________________ Plaintiff/Petitioner Vs. _______________________________ Defendant/Respondent Case No. ______________________ County of Winnebago Date _________________________ CHILD SUPPORT DATA SHEET OBLIGOR INFORMATION (Person Paying Child Support) OBLIGEE INFORMATION (Person Receiving Child Support) Last Name: First Name: Complete Residential Address: Middle In.: Last Name: First Name: Complete Residential Address: Middle In.: Complete Mailing Address (if other than above): Complete Mailing Address (if other than above): Date of Birth: *Social Security No.: Home Phone Number: ( ) Date of Birth: *Social Security No.: Home Phone Number: ( ) Employer(s) Name /Company: Employer(s) Name /Company: Child/Children Information Last 1. 2. 3. 4. 5. (If more space is needed, attach an additional sheet) First Middle In. Date of Birth *if obligor is not a U.S. citizen, so indicate and provide the obligor's alien registration number, passport number and home country's social security or national health number. American LegalNet, Inc. www.FormsWorkFlow.com