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Kansas Domestic Relations Affidavit Form

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Kansas Domestic Relations Affidavit Form
Kansas Domestic Relations Affidavit Form
Rev. 07/09 by KSJC
1 of 6
Domestic Relations Affidavit
IN THE
JUDICIAL DISTRICT
COUNTY, KANSAS
IN THE MATTER OF )
)
)
)
)
and ) Case No.
)
)
)
)
DOMESTIC RELATIONS AFFIDAVIT OF
(name)
1. Wife’s / Mother’s Residence
Wife’s / Mother’s
XXX-XX- _______
Birth Month/Year Social Security Number Telephone
2. Husband’s / Fathers Residence
Husband’s / Father’s
XXX-XX- _______
Birth Month/Year Social Security Number Telephone
3. Date of Marriage:
4. Number of Marriages:
Wife / Mother Husband / Father
5. Number of children of the relationship:
6. Names, Social Security Numbers, the month and year of each child’s birth and ages of minor children of
the relationship:
Name Social Security Number Birth Age Custodian
XXX-XX- _______ Month /Year
7. Names, Social Security Numbers, and ages of minor children of previous relationships and facts as to
custody and support payments paid or received, if any.
Social Support Paid
Name Security No. Age Custodian Payment or Rec’d
XXX-XX- _______
$
$
$
$
Kansas Domestic Relations Affidavit Form
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