Fill and Sign the Aoc Fc 3 490141742 Form

PETITIONER: RESPONDENT: Name: ______________________________________ Name: ______________________________________ Address: ____________________________________ Address: ____________________________________ ____________________________________________ ____________________________________________ ____________________________________________ ____________________________________________ Telephone: (include area code) ______________________ Telephone: (include area code) ______________________ Email: ______________________________________ Email: ______________________________________ DOB: _______________________________________ DOB: _______________________________________ SSN: _______________________________________ SSN: _______________________________________ Relationship to Respondent: _____________________ Relationship to Petitioner: _______________________ For ALL OTHER PARTIES to this case: please list below the name, current address, date of birth (DOB), social security number (SSN), and relationship to the Petitioner, of any other parties to this action, or children of the Petitioner or Re\ spondent. If there is not enough room below, please attach a separate sheet with all the information requested. OTHER PARTIES/CHILDREN: Name: ______________________________________ Name: ______________________________________ Address: ____________________________________ Address: ____________________________________ ____________________________________________ ____________________________________________ Telephone: (include area code) ______________________ Telephone: (include area code) ______________________ DOB: _______________________________________ DOB: _______________________________________ SSN: _______________________________________ SSN: _______________________________________ Relationship to Respondent: _____________________ Relationship to Petitioner: _______________________ Name: ______________________________________ Name: ______________________________________ Address: ____________________________________ Address: ____________________________________ ____________________________________________ ____________________________________________ Telephone: (include area code) ______________________ Telephone: (include area code) ______________________ DOB: _______________________________________ DOB: _______________________________________ SSN: _______________________________________ SSN: _______________________________________ Relationship to Respondent: _____________________ Relationship to Petitioner: _______________________ Please list any/all cases, pending, or heard within the last five (5) years, that have involved the parties or children of the parties in Family, District or Circuit Court. Please provide the case number, name of party and type of case: ________________________________________________________________________\ _______________________ ________________________________________________________________________\ _______________________ q CirCuit q DistriCt q Family C ourt Case D ata inFormation s heet AOC-FC-3 Rev. 10-17 Commonwealth of Kentucky Court of Justice www.courts.ky.gov q Minor Children Involved q Protective Order Issued For: q Petitioner q Respondent For Office Use Only Case #: ______________________ County: ______________________ Division: _____________________ NOTICE TO FILING PARTY: A REDACTED COPY MUST BE FILED PURSUANT TO CR 7.03. This form shall be completed in full, pursuant to local rule and in compliance with federal law. lex et justitia COMMONWEALTHOFKENTUCKY COURTOFJUSTICE DISTRIBUTION: Cabinet for Health and Family Services, placing a copy in the County Attorney's Wage Withholding Order Box in Circuit Clerk's Office _____________________________________________ Signature of Preparer/Relationship to Petitioner Print Name: ___________________________________ Address: _____________________________________ _____________________________________________ Telephone: (include area code) _______________________