CERTIFICATION
I hereby certify that, to the best of my knowledge and belief, the name, complete address
and telephone number of the other person involved in this action as listed below is:
(EE) Name of other party
Street number and name
City, State, ZIP
Telephone number
I have filed this Mandatory Case Disclosure with the Clerk of the _________________
Circuit Court, Family Division, and have mailed a copy of the Mandatory Case Disclosure and
supporting documentation to the other party involved in this action.
(FF) Signature
Date
13