IN THE DISTRICT COURT FOR COUNTY STATE OF OKLAHOMA In the Matter of: DOB: DOB: DOB: DOB: DOB: DOB: Deprived Child(ren) ) ) ) ) ) ) Case No. Judge PARENTAL / LEGAL GUARDIAN ADDRESS AND PHONE REGISTRATION FATHER MOTHER GUARDIAN _____________________________________________________________________________ NAME (FIRST, MIDDLE INITIAL, LAST) _____________________________________________________________________________ STREET ADDRESS _____________________________________________________________________________ CITY, STATE, ZIP CODE ____________________________________ HOME PHONE (WITH AREA CODE) ____________________________________ MESSAGE PHONE (WITH AREA CODE) ___________________________________ WORK PHONE (WITH AREA CODE) ___________________________________ DATE I UNDERSTAND THAT I MUST FILE ANY CHANGE IN MY ADDRESS WITH THE COURT AND THAT I MUST KEEP MY ATTORNEY AND THE COURT INFORMED OF MY CURRENT MAILING ADDRESS AND PHONE NUMBER AT ALL TIMES. I FURTHER UNDERSTAND THAT IF I FAIL TO FILE A CHANGE IN ADDRESS NOTICE WITH THE COURT, I MAY MISS A COURT APPEARANCE AND THE COURT MAY TAKE ACTION AGAINST MY INTERESTS IF I DO NOT APPEAR. [10A O.S. �1-4-603(D)] __________________________________________________________ SIGNATURE OF PARENT/GUARDIAN DATE:________________________________ Parental/Legal Guardian Address and Phone Registration OK-J-UF-0011 Version 1.1.16.2 Page 1 of 1 American LegalNet, Inc. www.FormsWorkFlow.com