Form Csed 04-1603 - Child Support Information Form (Page 2 of 4) in pdf

Form Csed 04-1603 - Child Support Information Form Page 2

LOCATE INFORMATION ON ABSENT PARENT

If a question does not apply to your situation, write "N/A" in the space. If you don't know the answer, write "UNKNOWN" in

the space.

Other Names Absent Parent May Use:

Date of Birth:

Age:

Place of Birth: ____________________________________________________

Race:

Height:

Weight:

Sex:

Eye Color:

Hair Color:

Scars, Marks, etc.:

Current/Last Known Residence Address:

Phone #:

City/State/Zip:

Current/Last Known Mailing Address (if different from above):

If the absent parent lives in another state now, has he/she ever lived or worked in Alaska? YES

If yes, give the last address in Alaska and the date he/she left the state:

Address:

Date left Alaska:

ASSET INFORMATION ABOUT THE ABSENT PARENT

His/her usual occupation:

Name of Employer:

Address of Employer:

Phone number:

Does the absent parent have medical insurance available for child(ren)? Yes

Unknown

If yes, name of insurance company:

Policy #:

Union(s) he/she belongs to:

Native Corporation(s) he/she belongs to:

Benefits he/she receives (for example: unemployment, retirement, disability, SSI, etc.):

_______________________________________________________________________________________________

Other known assets (for example: bank and credit union accounts, stocks, property, etc.):

__________________________________________________________________________________________________________

_____________________________________________________________________________________

CSED 04-1603 (Rev 09/13/00)

Page 2 of 3

Form Csed 04-1603 - Child Support Information Form Page 2