Nassau County Family Court Information Sheet Template
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1NCFC 2/2015
FILE #
Nassau County Family Court
DOCKET #
Information Sheet
(Court use only)
Print all information. Every box must be filled in. If you do not know the
information, print the word UNKNOWN.
Petitioner (Person filing petition)
Name:
(First)
(Middle)
(Last)
Maiden/Alias/Nickname:
(First)
(Last)
Address:
(Street)
(Apt. #)
(City)
(State)
(Zip Code)
(County)
If your residence address and mailing address are different, check here G, print mailing address in this section and
attach a separate paper with your name and residence address.
If your address is not known to the respondent and you are requesting that your address be kept confidential check
box here G.
Home Phone #: (
)
-
Work Phone #: (
)
-
Cell Phone #: (
)
-
Race: G American Indian/Alaskan Native
Date of Birth:
/
/
Ethnic Origin:
G Asian/Pacific Islander
G Black
G Hispanic
Sex: G Male G Female
G Other [specify]:
G White
G Non-Hispanic
Social Security #:
-
-
Height:
ft.
in.
Weight:
lbs
Eye Color:
Hair Color:
Distinguishing Marks:
Driver’s License ID #:
State:
G No
G Yes
Are you employed?
If yes, Employer’s Name:
Employer’s Address:
Respondent (Person you are filing petition against)
Name:
(First)
(Middle)
(Last)
Maiden/Alias/Nickname:
(First)
(Last)
Address:
(Street)
(Apt. #)
(City)
(State)
(Zip Code)
(County)
If the respondent’s residence address and mailing address are different, check here G, print mailing address in this
section and attach a separate paper with the respondent’s name and residence address.
Home Phone #: (
)
-
Work Phone #: (
)
-
Cell Phone #: (
)
-
Race: G American Indian/Alaskan Native
Date of Birth:
/
/
Ethnic Origin:
G Asian/Pacific Islander
G Black
G Hispanic
Sex: G Male G Female
G Other [specify]:
G White
G Non-Hispanic
Social Security #:
-
-
Height:
ft.
in.
Weight:
lbs
Eye Color:
Hair Color:
Distinguishing Marks:
Driver’s License ID #:
State:
G No
G Yes
Is respondent employed?
If yes, Employer’s Name:
Employer’s Address:
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