Confidential Information Form {DV 1.060}

Confidential Information Form (INFO) County: Cause Number: Do not file in a public access file. Court Clerk: This is a Restricted Access Document Divorce/Separation/Invalidity/Nonparental Custody/Paternity/Modifications Sexual Assault Other Domestic Violence Antiharassment Information Change (Check if you are updating information) A restraining order or protection order is in effect protecting the petitioner the respondent the children. The health, safety, or liberty of a party or child would be jeopardized by disclosure of address information because: The following information about the parties is required in all cases: (Use the Addendum To Confidential Information Form to list additional parties or children) Petitioner Information Name (Last, First, Middle) Race Sex Birth date Type or Print Only Respondent Information Name (Last, First, Middle) Race Sex Birth date Driver's Lic. or Identicard (# and State) Driver's Lic. or Identicard (# and State), (or, if unavailable, residential address) Mailing Address (P.O. Box/Street, City, State, Zip) Mailing Address (P.O. Box/Street, City, State, Zip) Relationship to Child(ren) Relationship to Child(ren) The following information is required if there are children involved in the proceeding. (Soc. Sec. No. is not required for petitions in protection order cases (Domestic Violence/Antiharassment/Sexual Assault.) 1) Child's Name (Last, First, Middle) Child's Race/Sex/Birth date Child's Soc. Sec. No. (If required) Child's Present Address or Whereabouts WPF DV-1.060 Confidential Information Form (INFO) (6/2006) - Page 1 of 2 American LegalNet, Inc. www.FormsWorkFlow.com 2) Child's Name (Last, First, Middle) Child's Race/Sex/Birth date Child's Soc. Sec. No. (If required) Child's Present Address or Whereabouts List the names and present addresses of the persons with whom the child(ren) lived during the last five years: List the names and present addresses of any person besides you and the respondent who has physical custody of, or claims rights of custody or visitation with, the child(ren): Except for petitions in protection order cases (Domestic Violence/Antiharassment/ Sexual Assault), the following information is required: Petitioner's Information Respondent's Information Soc. Sec. No.: Residential Address (Street, City, State, Zip) Soc. Sec. No.: Residential Address (Street, City, State, Zip) Telephone No.: ( Employer: Empl. Address: ) Telephone No.: ( Employer: Empl. Address: ) Empl. Phone No.: ( ) Empl. Phone No.: ( ) For Nonparental Custody Petitions only, list other Adults in Petitioner(s) household (Name/DOB): Additional information: Addendum(s) To Confidential Information Form attached. List other parties or children in Addendum(s). I certify under penalty of perjury under the laws of the state of Washington that the above information is true and accurate concerning myself and is accurate to the best of my knowledge as to the other party, or is unavailable. The information is unavailable because . Signed on __________________ [Date] at ____________________________________ [City and State]. Petitioner/Respondent WPF DV-1.060 Confidential Information Form (INFO) (6/2006) - Page 2 of 2 American LegalNet, Inc. www.FormsWorkFlow.com