Custody Information Form Page 2
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37.
Is the former parent currently employed? Yes___ No___. If yes, please provide:
a.
Name of employer _______________________ Length of employment ________
b.
Street address ______________________________________________________
c.
City, State, Zip _____________________________________________________
d.
Telephone number ________________
Job title? ______________________
e.
What is his or her monthly gross salary? $_______ Take home?______________
8.
Please give full name, date of birth and sex of each child, and indicate the name of the child’s other
parent.
First
Middle
Last
Sex
Social Security
Birthdate
Age
Name of Other Parent
Number
_______________________ M/F
___________
_________
_____ ____________________
_______________________ M/F
___________
_________
_____ ____________________
_______________________ M/F
___________
_________
_____ ____________________
_______________________ M/F
___________
_________
_____ ____________________
_______________________ M/F
___________
_________
_____ ____________________
9.
Please list the addresses where your children have lived and with whom for the last five years:
Child
Resided W ith
Address
Dates
10.
Were you married to the other parent? Yes_____ No ______.
If you were married to the other parent, please fill out the following:
a.
What is the date of your divorce judgment? ______________________________
b.
In what county did your divorce occur? __________________________________
c.
Have any orders been entered modifying the original judgment? Yes____ No____
d.
Please attach a copy of your divorce judgment and any modification orders.
11.
Restraining Order
a.
Have you ever had a restraining order against you? Yes____ No____ If yes, date_______
b.
Have you ever had a restraining order against somebody else? Yes____ No____ If yes,
date_______
c.
To the best of your knowledge, has the other parent ever had a restraining order against him or
her? Yes____ No____ If yes, date_______
d.
To the best of your knowledge, has the other parent ever had a restraining order against
somebody else? Yes____ No____ If yes, date_______
12.
Support
a.
Are you now paying support? Yes_____ No_____ If so, how much $__________
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Parent category: Legal