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                                                                             CONFIDENTIAL INFORMATION
                                                                        FOR USE ONLY BY THOSE AUTHORIZED BY
                                                                             Arkansas Code Annotated 9-14-205


                          Custodial Parent/Custodian: _________________________________________




                                                                                                                                                                                                                                                       Docket Number___________________
                          Residential Addr:___________________________________________________
                                                                        (Street)                                        (City)                           (St)              (Zip)


                          Mailing Addr:______________________________________________________
                                                                        (Street or PO Box)                               (City)                           (St)              (Zip)

                          Phone Numbers: (Home) _______________(Cell)_________________________

                          Social Security Number: __________________DOB:______________________

                          Driver’s License Number: (State)___________(Number)___________________




                                                                                                                                                                                                                  OCSE Case Number__________________
                          Employer’s Name or Business: ________________________________________

                          Address: ________________________________City:______________________

                          State: ______________________ Zip Code:_______________________________




                                                                                                                                                                                                                                                       Style of Case _____________________________________
                          Non-Custodial Parent: ______________________________________________

                          Residential Addr:___________________________________________________
                                                                        (Street)                                             (City)                       (St)             (Zip)

                          Mailing Addr:______________________________________________________
                                                                        (Street or PO Box)                                    (City)                       (St)            (Zip)


                          Phone Numbers: (Home) ________________ (Cell)________________________

                          Social Security Number: ___________________DOB:______________________

                          Driver’s License Number: (State)____________ (Number)__________________

                          Employer’s Name or Business: _________________________________________

                          Address: _______________________________City:________________________

                          State:_______________________ Zip Code:_______________________________


                          Children’s Names and Birth Dates:
                          Name:__________________________DOB:______________SSN:______________
                          Name:__________________________DOB:______________SSN:______________
                          Name:__________________________DOB:______________SSN:______________
                          Name:__________________________DOB:______________SSN:______________

                          Print or Type preparer’s name:_____________________________________________                                                                                                                                     AOC Form 35
                                                                                                                                                                                                                                            6/2005
This is confidential information and shall not be released to any person or entity except as authorized by law. The information is required to be submitted by the parties or their attorneys pursuant to ACA 9-14-205

				
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