400-00849 – Statement of Confidential Information (07/2013) Page 1 of 1
STATE
OF
VERMONT
SUPERIOR COURT
FAMILY DIVISION
Unit
Docket No.
P
laintiff Date Of Birth Defendant Date Of Birth
V.
STATEMENT OF CONFIDENTIAL INFORMATION
1. I am the Plaintiff Defendant in the above action.
2. For purposes of identification, my social security number is: _________________________
3. If known, the other party’s social security number is: _________________________
4. The social security numbers of the children involved in this case are:
Name of Child
Social Security #
THIS INFORMATION WILL BE KEPT CONFIDENTIAL AND WILL ONLY BE RELEASED WITH YOUR CONSENT
OR AS REQUIRED BY LAW TO THE OFFICE OF CHILD SUPPORT.