1. REASON WHY YOU ARE NOT PROVIDING YOUR SOCIAL SECURITY NUMBER
                   I do not have a Social Security number.
               
                   I do not know my Social Security number.
               
                   Other (explain)
               
               2. YOUR IDENTIFYING INFORMATION - This allows us to search our records for your Social
                  Security number.
               
               Your full first, middle, and last name:
               Your date of birth:
               Your place of birth:
               Your parent/mother's full first, middle, and maiden name:
               Your parent/father's full first, middle, and last name:
               3. REASON WHY YOU ARE NOT PROVIDING THE OTHER PARENT'S SOCIAL SECURITY NUMBER
                   Other parent does not have a Social Security number.
               
                   Other parent's Social Security number is not known.
               
                   Other (explain)
               
               4. OTHER PARENT'S IDENTIFYING INFORMATION – This allows us to search our records for
                  the other parent's Social Security number.
               
               Other parent's full first, middle, and last name:
               Other parent's date of birth:
               Other parent's place of birth:
               Other parent's parent/mother's full first, middle, and maiden name:
               Other parent's parent/father's full first, middle, and last name: