Free STATE OF WYOMING - Wyoming

STATE OF WYOMING COUNTY OF ________

) ) ss. )

IN THE DISTRICT COURT ___________ JUDICIAL DISTRICT Civil Action No. _____________

____________________, Plaintiff, vs. _____________________, Defendant.

) ) ) ) ) ) ) ) )

CONFIDENTIAL

CONFIDENTIAL STATEMENT FOR CHILD SUPPORT ORDER

The following information shall remain confidential and subject to inspection by persons other than the parties, their attorneys or the department of family services to the extent necessary to enforce the Child Support Enforcement Act and the Uniform Interstate Family Support Act only by court order and contains the: 1. The name and social security number of each parent: Name of Plaintiff: Plaintiff's Social Security Number: Name of Defendant: Defendant's Social Security Number: 2. The name and social security number of the child or children for whom child

support has been ordered: Child's Name: Child's Social Security Number: Child's Name: Child's Social Security Number: Child's Name: Child's Social Security Number:
DWCD 24 Confidential Statement for Child Support Order Revised July 2006 Page 1 of 2

Child's Name: Child's Social Security Number: DATED this _____ day of ______________________, 2_____. IN WITNESS WHEREOF, we have hereunto set our hands the day and year first above written. Signature Printed Name: Address: Phone Number:

CERTIFICATE OF SERVICE I certify that on (date) the original of this document

was filed with the Clerk of District Court; and, a true and accurate copy of this document was served on the other party by OR Hand Delivery OR Faxed to this number

by placing it in the United States mail, postage pre-paid, and

addressed to the following:

TO: ______________________________________ ______________________________________ ______________________________________

(Your signature)

Print name

DWCD 24 Confidential Statement for Child Support Order Revised July 2006 Page 2 of 2