NOTICE OF SOCIAL SECURITY NUMBER
(Petition for Temporary Custody by Extended Family in which involves two (2) minor children)
This filing confirms that the correct social security number was filed in a Broward County custody proceeding.
IN THE CIRCUIT COURT OF THE 17TH JUDICIAL CIRCUIT IN AND FOR BROWARD COUNTY, FLORIDA
In Re: The Matter of XXXX (a minor) Case Number:
JIMMY DOE,
Petitioner/Paternal Grandfather,
and
JANE DOE,
Mother,
JOHN DOE ,
Father.
____________________________/
NOTICE OF SOCIAL SECURITY NUMBER
I, JIMMY DOEE certify that my social security number ending with 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/19___.
X 1. This notice is being filed in a Petition for Temporary Custody by Extended Family in which involves two (2) minor children
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:
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.
VSR, born on xx/xx/20__
TPR, born on xx/xx/20__
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:_________________________
_______________________________
JIMMY DOE
STATE OF FLORIDA )
COUNTY OF BROWARD )
BEFORE ME, the undersigned authority, personally appeared JIMMY DOE 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: JANE DOE, Mother and JOHN DOE, Father by hand delivery.
SCHOTT & TOLCHINSKY, P.A.
Attorney for Petitioner
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.