Fill and Sign the Child Support Obligation Worksheet Required Location Form

CHILD SUPPORT OBLIGATION WORKSHEET REQUIRED LOCATION INFORMATION Court: ________________ Case No: _______ Petitioner: __________ Respondent: ________ As required by 62A-11-304.4, U.C.A., "Upon the entry of an order in a proceeding to establish paternity or to establish, modify, or enforce a support order, each party shall file identifying information and shall update that information as changes occur: (i) with the court or administrative agency that conducted the proceeding, and (ii) after October 1, 1998, with the state case registry." THE FOLLOWING INFORMATION MUST BE SUBMITTED AT THE TIME THE CHILD SUPPORT OBLIGATION WORKSHEET IS SUBMITTED. Whether you are the Petitioner or the Respondent, please fill out the information for yourself and the other party to the best of your ability. If any information is unknown, please so indicate. Do not leave any space blank. PETITIONER: I am the (check one) ____ custodial parent _____ non-custodial parent Social Security Number _____________ Driver License Number ____________ State _________ Residential Address ____________________________ Mailing Address (if different than residential address:) ___________________________________ Telephone Number: ____________ Date of Birth: _______ Employer: ___________________________ Employer's Address: _____________________________ Employer's Phone Number: ___________________ THIS INFORMATION IS CURRENT AS OF ___________ (date )RESPONDENT: Social Security Number _______________________ Driver License Number ____________ State _________ Residential Address __________________________________ Mailing Address (if different than residential address:) ________________________________________ Telephone Number: _______________Date of Birth: _____________ Employer: __________________________ Employer's Address: __________________________________ Employer's Phone Number: _____________________ THIS INFORMATION IS CURRENT AS OF _________ (date) Federal Law contains a prohibition against disclosing federal case registry information (name, social security number, date of birth, state) if the State has notified the registry there is reasonable evidence of domestic violence or child abuse or that disclosure of the information could be harmful to the parent or the child. If you wish to request the information be "safeguarded" (that is, not disclosed), check in the appropriate place below. _____________________ (Petitioner or Attorney for Petitioner) I request that this information be safeguarded (not disclosed) __ _____________________ (Respondent or Attorney for Respondent) I request that this information be safeguarded (not disclosed) ______ CHILD SUPPORT OBLIGATION WORKSHEET REQUIRED LOCATION INFORMATION AS REQUIRED BY TECHNICAL AMENDMENTS TO WELFARE REFORM SECTION 653(h)(2) (federal law) and U.C.A. 62A-11-103(14), THE FOLLOWING INFORMATION MUST BE SUBMITTED FOR EACH CHILD AT THE TIME THE CHILD SUPPORT OBLIGATION WORKSHEET IS SUBMITTED. Name: ___________________ Date of Birth: ________ Social Security Number: ___________ Name: __________________ Date of Birth: __________ Social Security Number: ______________ Name: ___________________ Date of Birth: ______________ Social Security Number: _______________ Name: _________________________ Date of Birth: ___________________ Social Security Number: _______________ Name: _________________________ Date of Birth: ___________________ Social Security Number: ________________________ Name: ____________________________ Date of Birth: ___________________ Social Security Number: ________________________ (Attach additional sheets if necessary)