Petition to Establish (SAPCR — Statewide) · Step 4 of 5
Signature & Certification
Petitioner's Signature
Sign your name here to show you agree with everything in this form. Only sign if you are the person filing.
Date
Write the date you are signing this form.
Petitioner's Name (Print)
Print your full name clearly so the court knows who filed this form.
Phone
Enter a phone number where the court can reach you.
Mailing Address
Enter the street address or PO box where you want to receive mail about this case.
City
Enter the city for your mailing address.
State
Enter the state for your mailing address.
Zip
Enter the ZIP code for your mailing address.
Email Address:
Enter your email address so the court can send you notices about this case.
Fax (if available)
Enter your fax number if you have one. You can leave this blank if you don't.
Petitioner's Signature
Sign here only if your child or children get (or once got) Medicaid or TANF. Your signature tells the judge you will send a copy of this form to the Attorney General Child Support office.
Date
Write the date you sign this form. Use the month, day, and year.
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