Date
/
Month
/
Day
Year
Date
Attorney (Office use only)
MWY
BEB
ZMP
EMC
Type of Case
Establish Guardianship
Dissolve Guardianship
Third-Party Custody
Your Information
You are:
*
Mother
Father
Guardian/Intervenor
Name
*
Address
*
City
*
State
*
ZIP
*
County of Residence
*
Phone Numbers: Cell
Format: (000) 000-0000.
Work
Other
Email Address
*
example@example.com
Date of Birth
*
Social Security Number (Last 4)
*
Average Weekly Income
Paid
Hourly
Salary
Employer
Employer Address
Other Party 1
Other Party 1 is
*
Mother
Father
Guardian/Intervenor
Name
*
Address
State
State
ZIP
County of Residence
Phone Numbers: Cell
Format: (000) 000-0000.
Work
Other
Date of Birth
/
Month
/
Day
Year
Date
Social Security Number
Work
Hourly
Salary
Employer
Employer’s Address
Employer’s Address
Average Weekly Income
Other Party 2 is:
*
Mother
Father
Guardian/Intervenor
Name
*
Address
City
State
ZIP
County of Residence
Phone Numbers: Cell
Format: (000) 000-0000.
Work
Other
Date of Birth
/
Month
/
Day
Year
Date
Social Security Number
Average Weekly Income
Paid
Hourly
Salary
Employer
Employer’s Address
Employer’s Address 2
Where to server other party, if applicable?
Work
Home
Case Information
If there is an existing case, is it from a
Divorce
Paternity Action
If there is an existing case, was it filed in Indiana?
Yes
No
If Yes, in what county was it filed?
If No, in what state and county was it filed?
Does the other party have an attorney?
Yes
No
Attorney’s name
Children
Rows
Name
Date of Birth
SSN
Gender
Highest Education Level
Which parent has custody of the children?
Mother
Father
In what County and State do the children currently reside?
Have they resided in their current state and county for the preceding six months?
No
Yes
If No, in what County and State did they previously reside?
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