Child Support - Cabarrus County

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CHILD SUPPORT APPLICATION SUPPLEMENTAL DATAPART TWO: CHILD(REN)2Complete the following information for each child.CHILD(REN) INFORMATIONChild’s NameChild’s Noncustodial ParentFirst Middle Last Suffix (e.g. Jr.)Date of Birth Race Sex Social Security NumberRelationship to you: Child Other (specify)Birthplace:City County StateWhere was child conceived? City State Child born out of wedlock? Yes NoFather named on child’s birth certificate:First Middle LastIs father named on birth certificate the biological father? Yes NoHas paternity been legally established? Yes No If yes, please state when , where and how below:When?Where?How? (Check one) By marriage In court Voluntary AcknowledgmentDid father sign Affidavit of Parentage at birth? Yes No Have paternity/genetic tests been performed? Yes NoHas father verbally acknowledged paternity? Yes No If yes, to whom?Does this child receive SSI or SSA? Yes NoCHILD(REN) INFORMATIONChild’s NameChild’s Noncustodial ParentFirst Middle Last Suffix (e.g. Jr.)Date of Birth Race Sex Social Security NumberRelationship to you: Child Other (specify)Birthplace:City County StateWhere was child conceived? City State Child born out of wedlock? Yes NoFather named on child’s birth certificate:First Middle LastIs father named on birth certificate the biological father? Yes NoHas paternity been legally established? Yes No If yes, please state when , where and how below:When?Where?How? (Check one) By marriage In court Voluntary AcknowledgmentDid father sign Affidavit of Parentage at birth? Yes No Have paternity/genetic tests been performed? Yes NoHas father verbally acknowledged paternity? Yes No If yes, to whom?Does this child receive SSI or SSA? Yes No
CHILD SUPPORT APPLICATION SUPPLEMENTAL DATAPART THREE: NONCUSTODIAL PARENT3Noncustodial Parent’s NameNONCUSTODIAL PARENT INFORMATIONFirst Middle Last Suffix (e.g. Jr.)Maiden Name(if appropriate)Alias/nickname/other names used:Date of Birth Race Sex Social Security Number(or age, if DOB is unknown)Relationship to you: Spouse Former Spouse None Other (specify)Marriage Date:Separation/Divorce Date:Mailing Address: Is this address Current or Last Known? (Check one) Home Phone:StreetCell Phone:City County State Zip CodeHome Address (if different from mailing address): Is this address Current or Last Known? (Check one)StreetCity County State Zip CodeBirthplace: City County StateHeight: Weight: Hair Color: Eye Color: Identifying Marks:Driver License Number:Vehicle Make/Model/Year:Usual Occupation:Father’s name:Mother’s name: (including maiden name)Most Recent Spouse’s Name (other than yourself):Marriage Date:State:Address:License Plate: Number and State:Address:Separation/Divorce Date:NONCUSTODIAL PARENT INCOME INFORMATIONEmployer’s name and address: Current or Last Known (Check one)IncomeList all sources in monthly gross amountsAmountSource$Employer’s Phone:$ TotalIs noncustodial parent self employed? Yes NoHas noncustodial parent ever been employed by a Federal Government Agency? Yes No If yes, name of agencyFederal Benefits? Yes No If yes, check all that apply:Social Security Postal VA RR Retirement Civil Service Military Retirement OtherUnemployment? Yes NoOther Income: Please list source and amount:
Page 1 and 2: CABARRUS COUNTYDepartment of Social
Page 3: For Office Use OnlyIVD Number Locat
Page 7: CABARRUS COUNTY CHILD SUPPORTCLIENT

Child Support - Cabarrus County

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