Confidential Information Form printable pdf download

Confidential Information Form

CONFIDENTIAL INFORMATION FORM (INFO)

County:

Cause Number:

Do not file in a

public access file.

COURT CLERK: THIS IS A RESTRICTED ACCESS DOCUMENT

Divorce/Separation/Invalidity/Nonparental Custody/Paternity/Modifications

Other

Domestic Violence

Antiharassment

Information Change (Check if you are updating information)

A restraining order or protection order is in effect protecting

the petitioner

the respondent

the children.

The health, safety, or liberty of a party or child would be jeopardized by disclosure of address

information because:

The following information about the parties is required in all cases:

(Use the Addendum To Confidential Information Form to list additional parties or children)

Type or Print only

Petitioner Information

Respondent Information

Name (Last, First, Middle)

Race

Sex

Birthdate

Race

Sex

Birthdate

Driver’s Lic. or Identicard (# and State)

Driver’s Lic. or Identicard (# and State), (or, if

unavailable, residential address)

Mailing Address (P.O. Box/Street, City, State, Zip)

Relationship to Child(ren)

The following information is required if there are children involved in the proceeding.

(Soc. Sec. No. is not required for petitions in protection order cases (Domestic Violence/Antiharassment).

1) Child's Name (Last, First, Middle)

Child's Race/Sex/Birthdate

Child's Soc. Sec. No. (If required)

Child's Present Address or Whereabouts

WPF DRPSCU 09.0200 Confidential Information Form (INFO) (12/2001) RCW 26.23.050- Page 1 of 2

Confidential Information Form