Confidential Family Court Information Sheet
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2NEVADA STATE DIVISION OF WELFARE AND SUPPORTIVE SERVICES
CHILD SUPPORT ENFORCEMENT
IN THE FAMILY DIVISION
OF THE ______________ JUDICIAL DISTRICT COURT OF THE STATE OF NEVADA
IN AND FOR THE COUNTY OF _______________
CONFIDENTIAL FAMILY COURT INFORMATION SHEET
Case No.
Plaintiff/Petitioner
vs.
Dept. No.
Defendant/Respondent
Mother/Wife Information
Father/Husband Information
Custodial Parent
Non-Custodial Parent
Custodial Parent
Non-Custodial Parent
Name:
Name:
Social Security Number:
Social Security Number:
Date of Birth:
Date of Birth:
Residential Address:
Residential Address:
City, State, Zip:
City, State, Zip:
Mailing Address:
Mailing Address:
Telephone No.:
Telephone No.:
Driver’s License No.:
Driver’s License No.:
Ethnicity:
White (Non Hispanic)
Hispanic
Ethnicity:
White (Non Hispanic)
Hispanic
African-American
Asian or Pacific Islander
African-American
Asian or Pacific Islander
Native American/Alaskan Native
Other
Native American/Alaskan Native
Other
Are you employed?
YES
NO
Are you employed?
YES
NO
Name of Employer:
Name of Employer:
Business Address:
Business Address:
City, State, Zip:
City, State, Zip:
Telephone No.:
Telephone No.:
CHILDREN OF THE PARTIES
Gender
Name:
SSN:
DOB:
M
F
Name:
SSN:
DOB:
M
F
Name:
SSN:
DOB:
M
F
Name:
SSN:
DOB:
M
F
Name:
SSN:
DOB:
M
F
If there are more than five (5) children, list their information on a separate sheet of paper and attach.
Does this case involve Family Violence:
YES
NO
Signature
Date
Signature
Date
(Page 1 of 2) 4094 - EC (4/10)
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