Disclosure Of Sealed Identifying Information In A Child Custody Proceeding {GF-178}

PRINT in BLACK ink Enter the name of the county in which you are filing this case. STATE OF WISCONSIN, CIRCUIT COURT, COUNTY In re: For Official Use Enter the name of the petitioner. Petitioner: First name Middle name Last name and Enter the name of the respondent. Note: Leave case number blank; the clerk will add this. Respondent: First name Middle name Last name Disclosure of Sealed Identifying Information in a Child Custody Proceeding Case No. This form is used in child custody proceedings with form GF-177. Enter the information you seek to withhold because of your belief that disclosure would jeopardize your health, safety, or liberty, or that of a minor child, such as: address, employer name and address, social security number, etc. UNDER OATH I STATE THAT: The identifying information about me or my minor children I am requesting to remain sealed because disclosure would jeopardize the health, safety, or liberty of myself or my minor children is as follows: 1. 2. 3. 4. 5. 6. 7. 8. See attached STOP! Take this document to a Notary Public BEFORE you sign it. After you have been sworn by a Notary Public, sign and print your name and date the document in front of the Notary Public. Petitioner Name Printed or Typed Date State of County of Subscribed and sworn to before me on Have the Notary Public sign, date and seal the document. Notary Public/Court Official (Seal) Name Printed or Typed My commission/term expires: GF-178, 10/06 Disclosure of Sealed Identifying Information in a Child Custody Proceeding This form shall not be modified. It may be supplemented with additional material. §822.29(5), Wisconsin Statutes American LegalNet, Inc. www.FormsWorkFlow.com