Form 04-1423a - Paternity Information Locate Sheet
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1
2STATE OF ALASKA
CHILD SUPPORT SERVICES DIVISION
Case No:
Child:
PATERNITY INFORMATION LOCATE SHEET
We need more information to help establish paternity for your child.
Please give us information about the person that you think is most likely to be the father.
This information is important to locate the correct person.
His full legal name (no nicknames):__________________________________________________
First
Middle
Last
Any other names he may have used:_________________________________________________
Social Security Number: ____________________Date of Birth or Approx. Age:_______________
Physical description
:___________________________________________________________________________
Height
Weight
Hair Color
Eye Color
Race
Scars/Marks
Mailing address: ________________________________________________________________________
City
State
Zip
Residence address: _____________________________________________________________
City
State
Zip
Work telephone number: ___________________Home number:__________________________
Did the noncustodial parent ever live or work in Alaska? No
Yes
When?______________
Place of birth: ______________Is the absent parent a citizen of the United States? Yes
No
If
no, what is his country of citizenship? _________________When did he last live there?_______
His usual occupation:_____________________________________________________________
Name of his current employer:_____________________________________________________
Month, date(s), and year of your sexual relationship with this man: From: _________To:________
Name any other men that you had sexual intercourse with around the time you became pregnant
(30 days before or 30 days after the child was conceived). Attach additional pages if necessary.
1) Full Name: __________________________________________________________________
First
Middle
Last
Address: ___________________________________________________________________
City
State
Zip
Social Security Number:____________ Date and Place of Birth: _______________Age:_____
Physical description: __________________________________________________________
Height
Weight
Hair Color
Eye Color
Race
Dates of sexual relations: From _____________________To __________________________
Why do you think that this man is not the father? ____________________________________
PLEASE COMPLETE AND SIGN THE BACK OF THIS PAGE
04-1423A (Rev 08/15/11)
MAT-SU: (907) 357-3550
SOUTHEAST: (907) 465-5887
TOLL FREE (In-state, outside Anchorage): (800) 478-3300
ANCHORAGE: (907) 269-6900
FAX: (907)787-3220
FAIRBANKS: (907) 451-2830
TDD machine only: (907) 269-6894 / TDD machine only, toll free (In-state, outside Anchorage): (800) 370-6894
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