Family Court Information Sheet {17}

TH IN THE 16 CIRCUIT COURT OF JACKSON COUNTY, MISSOURI FAMILY COURT DIVISION at Kansas City at Independence In Re the Matter of: Petitioner Case Number ___________________________ UNCONTESTED TRACK Respondent CONTESTED TRACK FAMILY COURT INFORMATION SHEET PETITIONER RESPONDENT Name Residential Address Mailing Address Social Sec. No. Drivers License No. Home Phone No. Employer Name Employer Address Employer Phone No. List all unemancipated children who are subjects of this proceeding: Name (last, first, middle) DOB Social Security No. Children Reside with: Petitioner Respondent To assist in determining child support, have any of these children ever received welfare or Medicaid? ___Yes ___No I certify that: There are no other related cases The following are the only cases pending or previously adjudicated in any court related to dissolution of marriage, custody, visitation, paternity, guardianship, adoption, child support, maintenance, abuse neglect or delinquenior t behav (by the minor child/ren), or adult abuse of or by any parties to this action. I further state that the parties to thhais veact bion een known by other names, as stated below: Indicate style of related case/case number/court and whether case is pending or closed: I state that the parties to this action have been known by the following other names: Each party shall have a continuing duty to update the information on this sheet as necessary until this matter has been dd. ispose Date:____________________ Petitioner/Respondent: ______________________________________________________ RULE 68.1 Filing Requirement Family Court Proceedings Circuit Court Form 17 Family Court Information sheet shall be completed and attached to all initial pleadings fileFad in tmilyhe C ourt Division Form 17 ( Att ach additional pages, if necessary) CIRCT 1452 04/24/01