Form Cssd 04-1423 - Information Locate Sheet (Page 2 of 2) in pdf

Form Cssd 04-1423 - Information Locate Sheet Page 2

OTHER INFORMATION: Please provide any further information that you think may be helpful in

obtaining support money for your children, such as bank account numbers, assets, stocks, property,

retirement programs, Native corporation memberships, etc.

___________________________________________________________________________________

NAMES AND ADDRESSES OF FRIENDS OR RELATIVES WHO MAY KNOW THE ADDRESS

OF THE NON-CUSTODIAL PARENT:

___________________________________________________________________________________

INFORMATION ABOUT THE CHILDREN:

Name

Date of Birth

Social Security No.

_____________________________________________________________________________________

Please list any payments made directly to you:

Month

Amount

Month

Amount

____________________________________

______________________________________

____________________________________

______________________________________

____________________________________

______________________________________

____________________________

______________________________________

Your Name (PLEASE PRINT)

Signature

Date

Work Telephone No: __________________

Home Telephone No: ____________________

Your address: _________________________________________________________________________

Your Social Security No. _______________________ Date of Birth: ____________________________

THANK YOU FOR THIS INFORMATION.

MAT-SU: (907) 357-3550

TOLL FREE (In-state, outside Anchorage): (800) 478-3300

SOUTHEAST: (907) 465-5887

ANCHORAGE: (907) 269-6900

FAX: (907) 269-6813 or 6914

FAIRBANKS: (907) 451-2830

TDD machine only: (907) 269-6894 / TDD machine only, toll free (In-state, outside Anchorage): (800) 370-6894

Form Cssd 04-1423 - Information Locate Sheet Page 2