TRAVIS COUNTY DOMESTIC RELATIONS OFFICE 1010 LAVACA STREET P.O. BOX 1495 AUSTIN, TEXAS 78767 512-854-9696 FAX 512-854-9819 www.traviscountydro.com APPLICATION FOR SERVICES Please complete this application packet, attach your check or money order made payable to: TRAVIS COUNTY DOMESTIC RELATIONS, in the amount of $20.00, sign the application, attach a photograph of the other parent, and return all papers to Travis County Domestic Relations. (Please Print all Information) INFORMATION ABOUT YOU: My Name:_______________________________________ DOB:______________ SSN:_____________________________ Street Address:________________________________________________ Apt.#__________________________________ City:____________________________________ State:_________________ Zip:__________________________________ Home Phone #:___________________________ Work Phone #:______________________ Ext.___________________ My relationship to the child(ren):_______________________________________________________________________ INFORMATION ABOUT THE OTHER PARENT: Name:____________________________________________________________________________________________________ Relationship to the child(ren):___________________________________________________________________________ LIST THE FOLLOWING INFORMATION FOR EACH CHILD: ________________________________________ ____________________ ____________________________________________ Name DOB Social Security No. ________________________________________ ____________________ ____________________________________________ Name DOB Social Security No. ________________________________________ ____________________ ____________________________________________ Name DOB Social Security No. American LegalNet, Inc. www.USCourtForms.com TRAVIS COUNTY DOMESTIC RELATIONS OFFICE APPLICATION FOR SERVICES PAGE 2 INFORMATION FOR EACH CHILD CONTINUED: ________________________________________ _____________________ ___________________________________________ Name DOB Social Security No. ________________________________________ ____________________ ___________________________________________ Name DOB Social Security No. I request all appropriate services of the Travis County Domestic Relations Office. The information contained in this application packet is true and complete. I have either read the attached information, or had it read to me. My signature is my agreement to the above statement and to the other information included in this application packet. __________________________________________ ________________________________ Signature Date Signed Further, by my signature below, I hereby grant permission to the Travis County Domestic Relations Division to provide my available addresses and telephone numbers to the other parent whenever requested by the other parent. I understand that this release will remain in effect until such time as I revoke it in writing. __________________________________________ ________________________________ Signature Date Signed American LegalNet, Inc. www.USCourtForms.com TRAVIS COUNTY DOMESTIC RELATIONS OFFICE APPLICATION FOR SERVICES PAGE 3 GENERAL INFORMATION Please print legibly and complete IN FULL the following information about the OTHER PARENT: First name:_________________________ MI:_________ Last name:___________________________________________ Birthdate:_____________/_____________/______________ SSN:______________-______________-_______________ Home phone:(__________)____________-____________ Pager number:(__________)___________-__________ Driver’s License number:__________________ Driver’s License Issuing State:____________________________ Mailing address:_______________________________________________________ Apt.#___________________________ City:__________________________________ State:__________________ Zip:____________________________________ Name of other persons living at residence:_____________________________________________________________ Relationship to Other Parent:____________________________________________________________________________ Physical address if different from mailing address: Street address:_______________________________________________________ Apt.#___________________________ City:_______________________________________ State:__________________ Zip:______________________________ Sex: Γ Male Γ Female Race: Γ Indian Γ Black Γ Hispanic Γ White Γ Other Skin: Γ Albino Γ Black Γ Dark Γ Dark Brown Γ Fair Γ Medium Γ Olive Γ Ruddy Γ Sallow Height:____________________ Weight:________________ lbs. Hair color: Γ Black Γ Blonde Γ Brown Γ Red Γ Gray Γ White Γ Sandy Γ Bald Eye color: Γ Blue Γ Brown Γ Green Γ Hazel Γ Black Scars, marks, tattoos, (please describe in detail):______________________________________________________________ _______________________________________________________________________________________________________________________ Other identifying characteristics: Γ Beard Γ Moustache Γ Glasses Γ Contacts Lens Γ Missing Teeth American LegalNet, Inc. www.USCourtForms.com TRAVIS COUNTY DOMESTIC RELATIONS OFFICE APPLICATION FOR SERVICES PAGE 4 BUSINESS/W0RK INFORMATION Company:________________________________ Address:______________________________________________________ Suite #:_______________ City:___________________ State:________________ Zip:_______________________________ Department:_______________________________ Phone #:(_______)_____________ Ext._________________________ Supervisor Name :______________________________ Work Hours:____________________________________________ OTHER ADDRESSES Where else might the he/she be found?_________________________________________________________________ Business or Residence:__________________________________________________________________________________ If Residence Who Lives There?________________________ Relationship:___________________________________ VEHICLE INFORMATION License Plate #:___________________________ Issuing State:______________________________________________ Vehicle Make:__________________ Model:__________________ Year________ Color:___________________________ OTHER INFORMATION Outstanding warrants: Γ Yes Γ No For:________________________________________________________________ Past arrests: Γ Yes Γ No For:__________________________________________________________________________ Convictions: Γ Yes Γ No For:___________________________________________________________________________ Currently on probation: Γ Yes Γ No Name of Probation Officer:______________________________________ What county:_______________________ Phone number: (______)_______________ Ext.________________________ Currently on parole: Γ Yes Γ No Name of Parole Officer:____________________________________________ What county:________________________ Phone number: (______)_______________ Ext._______________________ American LegalNet, Inc. www.USCourtForms.com TRAVIS COUNTY DOMESTIC RELATIONS OFFICE APPLICATION FOR SERVICES PAGE 5 OTHER INFORMATION Alcohol/Drug problems (explain):________________________________________________________________________ Serious Mental problems (explain):_____________________________________________________________________ Weapons owned: Γ Yes Γ No Type(s):_______________________________________________________________ History of violence towards others: Γ Yes Γ No Current Protective Order: Γ Yes Γ No If Yes, What county?:________________________________________ Cause number:______________________________ Date issued:_____________________________________________ ATTACH PHOTOGRAPH OF OTHER PARENT HERE American LegalNet, Inc. www.USCourtForms.com