NOTICE OF SOCIAL SECURITY NUMBER
IN THE CIRCUIT COURT OF THE 17TH JUDICIAL CIRCUIT IN AND FOR BROWARD COUNTY, FLORIDA
In Re: The Matter of Case Number:
JACK KING,
Petitioner/ Father,
and
JAMIE CROWN,
Respondent/Mother.
_______________________________/
NOTICE OF SOCIAL SECURITY NUMBER
I, JACK KING, certify that my social security number ending #XXXX, 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/1976.
X 1. This notice is being filed in a Petition for Paternity in which the parties have one (1) 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:
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:_________________________ _______________________________
JACK KING
STATE OF HAWAII )
)§:
COUNTY OF __________ )
BEFORE ME, the undersigned authority, personally appeared JACK KING, 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
________________, 20__.
______________________________
NOTARY PUBLIC
CERTIFICATE OF SERVICE
WE CERTIFY that a copy of the foregoing has been provided to: JAMIE CROWN, by personal service.
LAW OFFICES OF LARRY D. SCHOTT
Attorney for Father
By:____________________________
LARRY D. SCHOTT
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This document is a sample pleading related to a specific set of facts and circumstances and should not be used or relied upon for any family law matter. This document is being provided for illustrative purposes only. We recommend and urge you to consult with an experienced divorce lawyer for professional advice as each case is unique.
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