CHILD SUPPORT INFORMATION SHEET Please include all information known IN THE COURT OF JUDICIAL DISTRICT, CITY OF COUNTY, MISSISSIPPI Docket No. File Yr Chronological No. Clerk's Local ID Docket No. If Filed Prior to 1/1/94 Father: Last Address: Employer Name and Address: First M/I Jr/Sr etc. ( ) Phone # ( ) Employer Phone # Drivers License # Date of Birth Social Security # Mother: Last Address: Employer Name and Address: First M/I Jr/Sr etc. ( ) Phone # ( ) Employer Phone # Drivers License # Date of Birth Social Security # Child: Last Address: First M/I Jr/Sr etc. ( ) Phone # Date of Birth Social Security # Child: Last Address: First M/I Jr/Sr etc. ( ) Phone # Date of Birth Social Security # Child: Last Address: First M/I Jr/Sr etc. ( ) Phone # Date of Birth Social Security # Child: Last Address: First M/I Jr/Sr etc. ( ) Phone # FOR ADDITIONAL CHILDREN, PLEASE ATTACH ADDITIONAL FORMS Date of Birth Social Security # MANDATED PURSUANT TO: Federal Social Security Act Title IV-D, §§ 454(26)(A) and 454A(e)(4); Miss. Code Ann. §43-19-31(l)(iii) (Supp. 1999) Information will be sent to the ADMINISTRATIVE OFFICE OF COURTS AND MDHS CHILD SUPPORT ENFORCEMENT DIVISION American LegalNet, Inc. www.FormsWorkFlow.com