FILE #
DOCKET #
(Court use only)
NCFC 2/2015
Nassau County Family Court
Information Sheet
Print all information. Every box must be filled in. If you do not know the
information, print the word UNKNOWN.
Petitioner (Person filing petition)
Name: (First) (Middle) (Last)
Maiden/Alias/Nickname: (First) (Last)
Address: (Street) (Apt. #)
(City) (State) (Zip Code) (County)
If your residence address and mailing address are different, check here G, print mailing address in this section and
attach a separate paper with your name and residence address.
If your address is not known to the respondent and you are requesting that your address be kept confidential check
box here G.
Home Phone #: Work Phone #: Cell Phone #:
Date of Birth: Race: G American Indian/Alaskan Native
G Asian/Pacific Islander G Black
G Other [specify]: G White
Ethnic Origin:
G Hispanic
G Non-Hispanic
Sex: G Male G Female
Social Security #: Height: ft. in. Weight: lbs Eye Color: Hair Color:
Distinguishing Marks: Driver’s License ID #: State:
Are you employed? G No G Yes If yes, Employer’s Name:
Employer’s Address:
Respondent (Person you are filing petition against)
Name: (First) (Middle) (Last)
Maiden/Alias/Nickname: (First) (Last)
Address: (Street) (Apt. #)
(City) (State) (Zip Code) (County)
If the respondent’s residence address and mailing address are different, check here G, print mailing address in this
section and attach a separate paper with the respondent’s name and residence address.
Home Phone #: Work Phone #: Cell Phone #:
Date of Birth: Race: G American Indian/Alaskan Native
G Asian/Pacific Islander G Black
G Other [specify]: G White
Ethnic Origin:
G Hispanic
G Non-Hispanic
Sex: G Male G Female
Social Security #: Height: ft. in. Weight: lbs Eye Color: Hair Color:
Distinguishing Marks: Driver’s License ID #: State:
Is respondent employed? G No G Yes If yes, Employer’s Name:
Employer’s Address:
