SS Confidential Disclosure Form {CV-CR-FM-PC-200}

STATE OF MAINE UNIFIED CRIMINAL DOCKET SUPERIOR COURT DISTRICT COURT County:_________________ Location:________________ Docket No:______________ STATE OF MAINE/___________________________ Plaintiff v. _____________________________________________ Defendant SOCIAL SECURITY NUMBER CONFIDENTIAL DISCLOSURE FORM My Social Security account number is _____________ - ______ - _______________. Date: ____________________ ____________________________________ Plaintiff/Defendant Family Matter Cases Only (divorce, parental rights & responsibilities) 1. If this case is a Family Matter case, the child(ren) involved must also have their Social Security Number disclosed: Child's Name Social Security Number 2. A Protective Custody case is currently pending, Court/Docket Number: This form is confidential and shall not be disclosed unless ordered by the court. CV-CR-FM-PC-200, Rev. 07/15 Page 1 of 1 American LegalNet, Inc. www.FormsWorkFlow.com