Child Support Data Sheet {3399}

CHILD SUPPORT DATA SHEET - EXHIBIT 1 STATE OF ILLINOIS 3399 (Rev. 4/16) UNITED STATES OF AMERICA COUNTY OF DU PAGE IN THE CIRCUIT COURT OF THE EIGHTEENTH JUDICIAL CIRCUIT Support Account No. CHILD SUPPORT DATA SHEET OBLIGOR (NON CUSTODIAL PARENT) INFORMATION Last Name First Name Middle Circuit Court Case No. OBLIGEE (CUSTODIAL PARENT) INFORMATION Last Name First Name Middle Complete Residential Address Complete Residential Address Complete Mailing Address ( if other than above) Complete Mailing Address ( if other than above) Date of Birth Place of Birth Date of Birth Place of Birth Driver's License No. (state if other than Illinois) Driver's License No. (state if other than Illinois) Social Security No. or Alien Registration No. Social Security No. or Alien Registration No. Home Telephone/Area Code and Number Home Telephone/Area Code and Number Employer(s) Name/Company Employer(s) Name/Company Employer(s) Address Employer(s) Address Employer(s) FEIN Number Employer(s) FEIN Number Work Telephone/Area Code and Number Work Telephone/Area Code and Number CHILD/CHILDREN INFORMATION (Please list oldest to youngest) LAST NAME FIRST NAME M.I. DATE OF BIRTH SOCIAL SECURITY NO. EXHIBIT 1 CHRIS KACHIROUBAS, CLERK OF THE 18th JUDICIAL CIRCUIT COURT © WHEATON, ILLINOIS 60187-0707 American LegalNet, Inc. www.FormsWorkFlow.com