Pro Se (Self-Representation) Divorce Packet - State Of Kansas 6th Judicial District Page 50
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50SSN: ____________________________ (If SSN known, please provide)
Child #3: Name: ________________________________ Date of Birth: ____________ Gender:
Male/Female
SSN: ____________________________ (If SSN known, please provide)
Third Party Payee: ______________________________ Date of Birth: ____________ Gender:
Male/Female
SSN: __________________________________ (*If SSN not known, give reason for
unavailability of SSN)
______________________________________________________________________________
____________
Address, City, State, Zip:
_____________________________________________________________________
*Absent extenuating circumstances as determined by the Kansas Payment Center, Payers'
and Payees'
Social Security Numbers must be provided on this form.
Revised date: 6/20/06
Form Completed By: ________________________________________________________
Pro Se Divorce Packet
Page 50
Last Updated: 01//26/09
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