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Child Support Obligation Worksheet Required Location Information - Utah
| Child Support Obligation Worksheet Required Location Information Form. This is a Utah form and can be used in Child Support Statewide . |
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CHILD SUPPORT OBLIGATION WORKSHEET REQUIRED LOCATION INFORMATION Court: _ _______________________________ Case No: ______________________ Petitioner : ____________________________ Respondent : ______________________ As required by 62A-11-304.4, U.C.A., "Upon the entry of an order in a proceeding to establish paternity or toestablish, modify, or enforce a support order, each party shall file identifying information and shall update thatinformation as changes occur: (i) with the court or administrative agency that conducted the proceeding, and (ii)after October 1, 1998, with the state case registry." THE FOLLOWING INFORMATION MUST BE SUBMITTED AT THE TIME THE CHILD SUPPORT OBLIGATION WORKSHEET IS SUBMITTED. Whether you are the Petitioner or the Respondent, please f ill out the informationfor yourself and the other party to the best of your ability. If any information is unknown, please so indicate. Donot leave any space blank. PETITIONER: I am the (check one) _____ custodial parent _____ non-custodial parent Social Security Number _______________________________ Driver License Number ___________________________ State __________________ Residential Address ______________________________________________________________ Mailing Address (if different than residential address:) ______________________________________________________________________________ Telephone Number: _______________________ Date of Birth: _______________ Employer: _____________________________________________________ Employers Address: _______________________________________________________________ Employers Phone Number: _______________________________________ THIS INFORMATION IS CURRENT AS OF ___________________ (date ) RESPONDENT: Social Security Number __________________________________________________ Driver License Number ___________________________ State __________________ Residential Address ________________________________________________________________ Mailing Address (if different than residential address:) _________________________________________________________________________________ Telephone Number: __________________________Date of Birth: _____________________ Employer: _____________________________________________________ Employers Address: _____________________________________________________________ Employers Phone Number: _____________________________________ THIS INFORMATION IS CURRENT AS OF ___________________ (date) Federal Law contains a prohibition against disclosing federal case registry information (name, socialsecurity number, date of birth, state) if the State has notified the registry there is reasonable evidenceof domestic violence or child abuse or that disclosure of the information could be harmful to the parentor the child. If you wish to request the information be "safeguarded" (that is, not disclosed), check inthe appropriate place below. _____________________________________ (Petitioner or Attorney for Petitioner) I request that this information be safeguarded (not disclosed) ______ _____________________________________ (Respondent or Attorney for Respondent) I request that this information be safeguarded (not disclosed) ______ <<<<<<<<<********>>>>>>>>>>>>> 2CHILD SUPPORT OBLIGATION WORKSHEET REQUIRED LOCATION INFORMATIONAS REQUIRED BY TECHNICAL AMENDMENTS TO WELFARE REFORM SECTION 653(h)(2)(federal law) and U.C.A. 62A-11-103(14), THE FOLLOWING INFORMATION MUST BE SUBMITTEDFOR EACH CHILD AT THE TIME THE CHILD SUPPORT OBLIGATION WORKSHEET ISSUBMITTED. Name: ___________________________________________________ Date of Birth: ________________________________ Social Security Number: _____________________________________ Name: ___________________________________________________ Date of Birth: ________________________________ Social Security Number: _____________________________________ Name: ___________________________________________________ Date of Birth: ________________________________ Social Security Number: _____________________________________ Name: ___________________________________________________ Date of Birth: ________________________________ Social Security Number: _____________________________________ Name: ___________________________________________________ Date of Birth: ________________________________ Social Security Number: _____________________________________ Name: ___________________________________________________ Date of Birth: ________________________________ Social Security Number: _____________________________________ (Attach additional sheets if necessary)
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