Email at the above noted number: Yes ____ No ____
5.This case involves child support issues. Yes ____ No ____ (If yes, supply social security numbers for all family members on a separately attached document filed as confidential information on light green paper. Use Form TCM-TR3.1-4.)
6.This case involves a protection from abuse order, a workplace violence restraining order, or a no – contact order. Yes ____ No ____ (If Yes, the initiating party must provide an address for the purpose of legal service but that address should not be one that exposes the whereabouts of a petitioner.) The party shall use the following address for purposes of legal service:
________ |
Attorney’s address |
________ |
The Attorney General Confidentiality program address |
|
(contact the Attorney General at 1-800-321-1907 or e-mail address is |
|
confidential@atg.state.in.us). |
________ |
Another address (provide) |
______________________________________________________________
7.This case involves a petition for involuntary commitment. Yes ____ No ____
8.If Yes above, provide the following regarding the individual subject to the petition for involuntary commitment:
a.Name of the individual subject to the petition for involuntary commitment if it is not already provided in #1 above: ____________________________________________
b.State of Residence of person subject to petition: _______________
c.At least one of the following pieces of identifying information:
(i)Date of Birth ___________
(ii)Driver’s License Number ______________________
State where issued _____________ Expiration date __________
(iii)State ID number ____________________________
State where issued _____________ Expiration date ___________
(iv)FBI number __________________________
(v)Indiana Department of Corrections Number _______________________
(vi)Social Security Number is available and is being provided in an attached confidential document Yes ____ No ____
9.There are related cases: Yes ____ No ____ (If yes, list on continuation page.)
10.Additional information required by local rule:
_____________________________________________________________________