DOMESTIC PARTY INFORMATION

CONFIDENTIAL DOMESTIC PARTY INFORMATION

Keith County District Court

Any order for support entered by the court shall specifically provide that any person ordered to pay a judgment shall be required to furnish to the Clerk of the District court his or her address, telephone number and social security number, the name of his or her employer, and any other information the Court shall deem relevant until such judgment shall be paid in full. The person shall also be required to advise the Clerk of any changes in such information between the time of entry of the order and the payment of the judgment in full.

Please complete the following form and submit to the Clerk of the District Court. The information will be entered into the JUSTICE system and then shredded.

Case Number________________________

Plaintiff name______________________________________________ d/o/b____________________

Male/Female____ Social Security number______________________ Phone number_______________

Address____________________________________________________________________________

___________________________________________________________________________________

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Defendant name__________________________________________ d/o/b_______________________

Male/Female____ Social Security number______________________ Phone number________________

Address_____________________________________________________________________________

____________________________________________________________________________________

___________________________________________________________________________________

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Children:

Name___________________________________________________d/o/b_______________________