NOTICE OF SOCIAL SECURITY NUMBER
(Post Judgment Paternity case in which the parties have one minor child)
IN THE CIRCUIT COURT OF THE 11TH JUDICIAL CIRCUIT IN AND FOR MIAMI-DADE COUNTY, FLORIDA
In Re: The Matter of Case Number:
Section
KING JACK,
Petitioner/Father,
and
JAMIE CROWN
and
JOHN SHMIT,
Respondent/Mother.
_________________________________/
NOTICE OF SOCIAL SECURITY NUMBER
I, KING JACK, certify that my social security number ending #XXX as required in section 61.052(7), sections 61.13(9) or (10), section 742.031(3), sections 742.032(1)-(3), and/or sections 742.10(1)-(2), Florida Statutes. My date of birth is xx/xx/19__.
X 1. This notice is being filed in a Post Judgment Paternity case in which the parties have one minor child.
2. This notice is being filed in a paternity or child support case, or in a dissolution of marriage in which the parties have minor children in common. The minor child’s names, dates of birth, and social security numbers are:
NSP, born on xx/xx/20__
Disclosure of my social security number(s) shall be limited to the purpose of administration of the Title IV-D program for child support enforcement.
I understand that I am swearing or affirming under oath to the truthfulness of the claims made in this notice and that the punishment for knowingly making a false statement includes fines and/or imprisonment.
Dated:_________________________ _______________________________
KING JACK
Father
STATE OF FLORIDA )
)§:
COUNTY OF BROWARD )
BEFORE ME, the undersigned authority, personally appeared KING JACK known to me or who produced __________________ as identification, under penalties of perjury and having been sworn under oath, verifies that the above contents and information is true and correct to the best of his personal knowledge and that he executed this document.
WITNESS my hand and seal in the State and County aforesaid this ___ day of
________________, 20__.
______________________________
NOTARY PUBLIC
CERTIFICATE OF SERVICE
WE CERTIFY that a copy of the foregoing has been provided to: Jamie Crown Mother, by personal service.
LARRY D. SCHOTT
Attorney for Father
By:____________________________
LARRY D. SCHOTT
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