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: