NOTICE OF SOCIAL SECURITY NUMBER
(Petition for Modification in which the parties have three (3) minor children)
IN THE CIRCUIT COURT OF THE 17TH JUDICIAL CIRCUIT IN AND FOR BROWARD COUNTY, FLORIDA
In Re: The Former Marriage of Case Number:
JAMIE CROWN,
Petitioner/Former Wife,
and
JACK KING,
Respondent/Former Husband.
_____________________________________/
NOTICE OF SOCIAL SECURITY NUMBER
I, JAMIE CROWN, certify that my social security ending numbers are 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 xx-xx-1984.
X 1. This notice is being filed in a Petition for Modification in which the parties have three (3) minor children.
- 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 children’s names, dates of birth, and social security numbers are:
XX, born on xx/xx/20__
XX, born on xx/xx/20__
XX, 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:_________________________
____________________
JAMIE CROWN
Petitioner/ Former Wife
STATE OF FLORIDA )
)§:
COUNTY OF BROWARD )
BEFORE ME, the undersigned authority, personally appeared, JAMIE CROWN 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 her personal knowledge and that she executed this document.
WITNESS my hand and seal in the State and County aforesaid this ______ day of XXXXX 20__.
______________________________
NOTARY PUBLIC
CERTIFICATE OF SERVICE
I HEREBY CERTIFY that a true and correct copy of the foregoing was provided to: Jack King, Former Husband, by personal service.
LARRY D. SCHOTT
Attorney for Former Wife
By:____________________________
LARRY D. SCHOTT
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