Free Statement of Social Security Number - Maryland


File Size: 7.0 kB
Pages: 1
Date: July 28, 2006
File Format: PDF
State: Maryland
Category: Court Forms - Federal
Author: fkessler
Word Count: 64 Words, 686 Characters
Page Size: Letter (8 1/2" x 11")
URL

http://www.mdd.uscourts.gov/publications/forms/statementsocsecno.pdf

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CONFIDENTIAL INFORMATION
THIS DOCUMENT MUST BE SERVED ON THE GOVERNMENT ALONG WITH THE SUMMONS AND COMPLAINT. IT IS NOT TO BE FILED WITH THE COURT. IN THE UNITED STATES DISTRICT COURT FOR THE DISTRICT OF MARYLAND _____________________________ vs. COMMISSIONER, SOCIAL SECURITY : : : CIVIL ACTION NO. _______________

STATEMENT OF SOCIAL SECURITY NUMBER

Social Security Number of Claimant:

Social Security Number of Worker (if different than claimant):

_____________ (Date)

________________________________________________ (Signature) ________________________________________________ ________________________________________________ ________________________________________________