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DATE: _____________________

Please answer each question in full. Use the back of the page and extra paper if needed.

_______________________________________________________________________(___________________)

NAME:

(

LAST)

FIRST)

(MIDDLE)

(MAIDEN or OTHER NAMES

YOU HAVE GONE BY)

ADDRESS: _________________________________________________________________________________________________

(

STREET)

CITY)

STATE)

ZIP)

PHONE NUMBER: ________________________________

CELL NUMBER: ______________________________________

WORK NUMBER: ________________________________

EMAIL: _____________________________________________

WHAT IS THE BEST WAY TO CONTACT YOU? _______________________________________________________________

BIRTHDATE: _________________

BIRTHPLACE: _________________________________________________________

SEX: ______

RACE/ETHNICITY________________________

SOCIAL SECURITY NO. __________________________ DRIVER’S LICENSE NO. _________________________________

(SPECIFY STATE)

YOUR RELATIONSHIP TO THE CHILD/REN IN QUESTION: ___________________________________________________

FAMILY HISTORY:

YOUR FATHER’S NAME: ______________________________________ AGE: ______ PHONE NO. ______________________

ADDRESS: _______________________________________________________OCCUPATION: ____________________________

IF DECEASED, AGE AND YEAR HE DIED: _____________________________________________________________________

YOUR MOTHER’S NAME: ______________________________________ AGE: ______ PHONE NO.______________________

ADDRESS: _______________________________________________________ OCCUPATION: ____________________________

IF DECEASED, AGE AND YEAR SHE DIED: ____________________________________________________________________

NO. OF BROTHERS: _____________

NO. OF SISTERS: ____________

NO. OF HALF/STEP-SIBLINGS: ___________

LIST: NAME, ADDRESS AND PHONE NUMBERS OF YOUR BROTHERS, SISTERS, HALF AND STEP-SIBLINGS

______________________________________________________________________________________________________________________________________

Personal Data Form And Social Study Information Sheet - Tarrant County Family Court Services Page 3