rule 17.200 form 203: confidential information form
TRANSCRIPT
Rule 17.200—Form 203: Confidential Information Form
December 2013 Rule 17.200—Form 203 Page 1 of 2
This form is to be used by paper filers only.
Each party must complete one of these forms if filing in paper.
Iowa Code section 602.6111 requires the parties to a case to provide the clerk of court with certain personal identification information. Each party’s completed form will be kept confidential by the clerk of court.
If you do not understand how to use this form, or if you should use this form, talk to an attorney.
In the Iowa District Court for County County where your case is filed
Upon the Petition of
Petitioner Full name: first, middle, last
The spouse who files the Petition
and concerning
Respondent Full name: first, middle, last
The other spouse
Equity case no.
Confidential Information Form
1. Petitioner’s Information
/ / - -
Full name: first, middle, last Birth date Social Security number
2. Respondent’s Information
/ / - -
Full name: first, middle, last Birth date Social Security number
3. Children’s Information
Child 1: / / - -
Full name: first, middle, last Birth date Social Security number
Child 2:
/ / - -
Full name: first, middle, last Birth date Social Security number
Child 3: / / - -
Full name: first, middle, last Birth date Social Security number
Child 4: / / - -
Full name: first, middle, last Birth date Social Security number
Continued on next page
Rule 17.200—Form 203 Confidential Information Form, continued
December 2013 Rule 17.200—Form 203 Page 2 of 2
Child 5: / / - -
Full name: first, middle, last Birth date Social Security number
Check this box if you have attached a separate sheet listing additional children.
4. Signature of Provider of Information
Information provided by: Print your full name: first, middle, last
, 20 Your signature Month Day Year
Important Notice: Do not give copies of this form to anyone except the clerk of court.