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Confidential Information Form - Iowa

Confidential Information Form Form. This is a Iowa form and can be used in Civil District Court Statewide .
 Fillable pdf Last Modified 7/6/2005
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IN THE IOWA DISTRICT COURT FOR ________________________COUNTY ________________________________________________________________________ ___ ) _________________________________, ) Case No. _____________________ Petitioner/Plaintiff, ) ) CONFIDENTIAL ) 598.22b & 602.6111(2) v. ) FORM _________________________________, ) Respondent/Defendant ) ________________________________________________________________________ ___ Please note: This form is for the submission of information required by 598.22B and 602.6111(2). Parties are encouraged, but not required, to complete and sign a joint form. Please print or type all information. Petitioner/Plaintiff Name: (Last)___________________________(First)_______________(Middle)_ __________ Address: _______________________________________________________________ _____ City___________________________ State_____________Zip code__________ _________ Social Security No.: ___________________ Drivers License No.: ______ ________________ DOB: _______________________________ Telephone No: (____)_____________ _________ Employer: _______________________________________________________________ ____ Employers Address: ___________________________________________________ ________ City___________________________ State_____________Zip code__________ __________ Employers Telephone No: (_____)___________________________ Respondent/Defendant Name: (Last)___________________________(First)_______________(Middle)_ __________ Address: _______________________________________________________________ _____ City___________________________ State_____________Zip code__________ _________ Social Security No.: ___________________ Drivers License No.: ______ ________________ DOB: _______________________________ Telephone No: (____)_____________ _________ Employer: _______________________________________________________________ ___ Employers Address: ___________________________________________________ _______ City___________________________ State_____________Zip code__________ _________ Employers Telephone No: (_____)___________________________ <<<<<<<<<********>>>>>>>>>>>>> 2 Child/Children (1) Name: (Last)________________________(First)_______________(Middle)___________ Social Security No: _____________________ DOB: _________________________________ (2) Name: (Last)________________________(First)_______________(Middle)___________ Social Security No: _____________________ DOB: __________________________________ (3) Name: (Last)________________________(First)_______________(Middle)___________ Social Security No: _____________________ DOB: __________________________________ (4) Name: (Last)________________________(First)_______________(Middle)____________ Social Security No: _____________________ DOB:___________________________________ (5 Name: (Last)________________________(First)_______________(Middle)_____________ Social Security No: _____________________ DOB: ___________________________________ The party/parties submit the above information in comnce with the Courts Order and with the knowledge the plia information will be used to enforce any support Order under Chapters 234, 252A, 252C, 252F, 252H, 252K, 600B, as provided for in Sections 598, The Code, and 602.6111(2), The Code. The parties have a duty to promptly file with the Clerk of the District Court or the Child Support Recovery Unit an update of this information if their address or employment change. Dated this __________ day of ______________________________, ___________. ___________________________________ __________________________________________ Signature of Petitioner/Plaintiff Printed Name of Petitioner/Plaintiff ___________________________________ __________________________________________ Signature of Respondent/Defendant Printed Name of Respondent/Defendant ___________________________________ _________________________________________ Signature of Attorney for Petitioner/Plaintiff Signature of Attorney for Respondent/Defendant
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