General Testimony (Page 16 of 30) in pdf

SECTION I, PERSONAL INFORMATION ABOUT CHILD(REN)'S MOTHER: This section asks for

information about the child(ren)'s mother. If the mother is the respondent in this action, this

information will be used to identify her, locate her, discover income and assets, begin the process of

determining her ability to pay, and/or effect collection actions. If the mother is the respondent and

needs to be located, also attach a completed "Locate Data Sheet".

If the individual completing this form is not the child(ren)'s mother, that individual may not be able to

provide all of the requested information. Provide as much information as possible.

Part A

Item 1: Indicate whether the child(ren)'s mother is the "Obligee" or "Obligor".

Item 2: Check this box if a nondisclosure finding pursuant to the Uniform Interstate Family Support

Act (UIFSA) or an existing protective order excuses disclosure of the mother's address or other

identifying information. Attach a copy of any nondisclosure finding. If a nondisclosure finding exists,

do not enter the mother's address/identifying information on the form; you may enter a substitute

address.

Item 3: Enter the mother's full name (First, Middle, Last), including nickname or alias.

Item 4: Enter the mother's home or residential address (Street, City, State, Zip Code). If this address

has been confirmed/verified by the initiating State agency, check the box indicating that the

information has been confirmed and the date it was confirmed. If the address cannot be confirmed,

provide last known address.

Item 5: Enter the mother's Social Security Number.

Item 6: Enter the mother's date of birth (Month, Date, Year).

Item 7: Enter the mother's home phone number. Include the area code.

Item 8: Enter the mother's work phone number. Include the area code.

Item 9: Enter the name and address of the mother's employer. If this information has been

confirmed/verified by the initiating State agency, check the box indicating that the information has

been confirmed and the date it was confirmed. If the employer name and address cannot be

confirmed, provide last known information.

Item 10(a): Enter the mother's occupation, trade, or profession.

Item 10(b): Enter the mother's highest attained level of education. If the mother is the obligor, the

educational level can be used by some responding States to impute the income of an unemployed or

underemployed obligor.

Item 11: Enter the dollar amount of the mother's estimated gross monthly earnings.

Item 12: Enter the dollar amount of the mother's monthly income other than earnings. Indicate the

source of the income.

Item 13: List any real or personal property owned by the mother. Include type and location.

Part B: Physical Description of Child(ren)'s Mother

Instructions for General Testimony--Page 3

General Testimony Page 16