Confidential Case Filing Information Sheet Domestic Relations {FI-10}

Case Number (For Court Use Only) ___________________________ CONFIDENTIAL CASE FILING INFORMATION SHEET ­ DOMESTIC RELATIONS CASES Required at Case Initiation and with Responsive Filings INSTRUCTIONS: Complete this form for all parties known at the time of filing. Provide the most appropriate Case Type and Party Type codes and descriptions. (Found on the Case Types List and Party Types List at www.courts.mo.gov on the Court Forms/Filing Information page.) If additional space is needed, complete additional Confidential Case Filing Information Sheets. NOTE: The full Social Security Number (SSN) is required pursuant to Section 509.520 RSMo. This is a confidential document due to the SSN and possible confidential addresses. This information is used to open a case in the courts case management system. While cases deemed public under Missouri statutes can be accessed through Case.net, the day and month of birth, SSN, and confidential addresses are NOT provided to the public through Case.net. Filing Date: Style of Case: (i.e. Petitioner v. Respondent) County/City of St. Louis: Case Type Code: Case Type Description: Petitioner/Plaintiff Information: Party Type Code: Name: (Last) Address: City: DOB: State: Gender: Zip: Male Female Contact Telephone Number: SSN: Bar ID: Party Type Code: Party Type Description: (First) (Middle) Attorney Name (if represented by counsel): Respondent/Defendant Information: Party Type Code: Name: (Last) Address: City: DOB: State: Gender: Zip: Male Female Contact Telephone Number: SSN: Bar ID: Party Type Code: Party Type Description: (First) (Middle) Attorney Name (if represented by counsel): Party Type Code: Name (if person): (Last) Organization (if non-person): Address: City: DOB: Party Type Description: (First) (Middle) State: Gender: Zip: Male Female Contact Telephone Number: SSN: Bar ID: Party Type Code: Attorney Name (if represented by counsel): Party Type Code: Name (if person): (Last) Organization (if non-person): Address: City: DOB: Party Type Description: (First) (Middle) State: Gender: Zip: Male Female Contact Telephone Number: SSN: Bar ID: Party Type Code: Attorney Name (if represented by counsel): OSCA (05-13) FI-10 www.FormsWorkFlow.com Case Number (For Court Use Only) ___________________________ Employer Information Petitioner/Plaintiff Employer Name: Employer Address: City: State: Zip: Contact Telephone Number: Respondent/Defendant Employer Name: Employer Address: City: State: Zip: Contact Telephone Number: The following information regarding children is required. Complete this section for any child subject to the action of this case. *MACSS ­ Missouri Automated Child Support System Children: Name: Gender: Male Female SSN: SSN: Male Female DOB: DOB: DOB: DOB: DOB: DOB: DOB: DOB: DOB: DOB: Optional: MACSS Member Number (to be completed by the court): Name: Gender: Optional: MACSS Member Number (to be completed by the court): Name: Gender: Male Female SSN: SSN: Male Female Optional: MACSS Member Number (to be completed by the court): Name: Gender: Optional: MACSS Member Number (to be completed by the court): Name: Gender: Male Female SSN: SSN: Male Female Optional: MACSS Member Number (to be completed by the court): Name: Gender: Optional: MACSS Member Number (to be completed by the court): Name: Gender: Male Female SSN: SSN: Male Female Optional: MACSS Member Number (to be completed by the court): Name: Gender: Optional: MACSS Member Number (to be completed by the court): Name: Gender: Male Female SSN: SSN: Male Female Optional: MACSS Member Number (to be completed by the court): Name: Gender: Optional: MACSS Member Number (to be completed by the court): Check if more than ten children and attach additional sheet Submitted by: Address (if not shown on previous page): City: Phone: Email Address: State: Zip: Bar ID (required if attorney): *IMPORTANT: It is the parties' responsibility to keep the court informed of any change of address or employment.* Instructions to Clerk Maintain the closed portion(s) of the record in a sealed manila envelope within the file. The file can be maintained with other open records. If a request is made to review the open portion of the file, the envelope can be removed from the file. Access to the record must be restricted to avoid access to the closed portion of the record. OSCA (05-13) FI-10 www.FormsWorkflow.com