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FAMILY COURT INFORMATION SHEET PETITIONER S INFORMATION DATE For Support Cases only CSMS AKA NAME DATE OF BIRTH SS INMATE ID NYSID RACE HOME PHONE WHITE ETHNICITY BLACK NATIVE AMERICAN HISPANIC CPS CIN ASIAN/PACIFIC ISLANDER OTHER UNKNOWN NON-HISPANIC MAILING ADDRESS RESIDENCE ADDRESS WITH DIRECTIONS EMPLOYED EMPLOYER S ADDRESS HEALTH INSURANCE COVERAGE WORK PHONE YES NO MEDICAL OPTICAL DENTAL NAME AND ADDRESS OF HEALTH INSURANCE CARRIER DATE OF .

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