New Jersey Child Custody FormNew Jersey Child Custody FormNew Jersey Child Custody Form
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GENERAL TESTIMONY

Petitioner: Name (first, middle, last)
Social Security Number

IV-D Case: [
[
[
[
[

Respondent: Name (first, middle, last)
Social Security Number

] TANF
] IV-E Foster Care
] Medicaid Only
] Former Assistance
] Never Assistance

File Stamp

Non-IV-D Case: [ ]
Responding IV-D Case Number
Responding Tribunal Number

Initiating IV-D Case Number
Initiating Tribunal Number

Petitioner is:

Respondent is:

[ ] Obligee

[ ] Caretaker Other than Parent

[ ] Obligor

[ ] Foster Care

[ ] Obligee

[ ] Caretaker Other than Parent

[ ] Obligor

[ ] Foster Care

____________________________________________ being duly sworn, under penalties of perjury, testifies as follows:
Name (first, middle, last)

I. Personal Information About Child(ren)'s Mother
A.1. Mother is:

[ ] Obligee

[ ] Obligor

[ ] See Section X
2.

[ ] Nondisclosure Finding Attached

3. Full Name (first, middle, last)
Nickname, alias, maiden name, former married name, etc.
4. Home Address

9. Employer

[ ]

Confir