90fdce07-c6ae-4263-92db-680eed562b05_PreTrialStatementConfInfoFormParentingPlanHistoryVerificationPacket080524_need_help-artifacted.pdf — PaddleOCR-VL (Baidu)

CONFIDENTIAL INFORMATION FORM

Case Records Public Access Policy of the Unified Judicial System of Pennsylvania 204 Pa. Code § 213.81 www.pacourts.us/public-records

Party name as displayed in case caption

Docket/Case No

(Party name as displayed in case caption)

Docket/Case No.

Vs.

Party name as displayed in case caption

Court

(Party name as displayed in case caption) Court

This form is associated with the pleading titled ___, dated___, ___.

dated

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Pursuant to the Case Records Public Access Policy of the Unified Judicial System of Pennsylvania, the Confidential Information Form shall accompany a filing where confidential information is required by law, ordered by the court, or otherwise necessary to effect the disposition of a matter. This form, and any additional pages, shall remain confidential, except that it shall be available to the parties, counsel of record, the court, and the custodian. This form, and any additional pages, must be served on all unrepresented parties and counsel of record.

This Information Pertains to:	Confidential Information:	References in Filing:
	Social Security Number (SSN):	Alternative Reference:SSN 1
(full name of adult)ORThis information pertains to a minor with the initials of ___ and the full name of	Financial Account Number (FAN):	Alternative Reference:FAN 1
	Driver License Number (DLN):	Alternative Reference:DLN 1
(full name of minor)and date of birth: ___	State of Issuance:	Alternative Reference:SID 1
(full name of minor)and date of birth: ___	State Identification Number (SID):	Alternative Reference:SID 1
	Social Security Number (SSN):	Alternative Reference:SSN 2
(full name of adult)ORThis information pertains to a minor with the initials of ___ and the full name of	Financial Account Number (FAN):	Alternative Reference:FAN 2
	Driver License Number (DLN):	Alternative Reference:DLN 2
(full name of minor)and date of birth: ___	State of Issuance:	Alternative Reference:SID 2
(full name of minor)and date of birth: ___	State Identification Number (SID):	Alternative Reference:SID 2

full name of adult

Financial Account Number (FAN

Driver’s License Number (DLN

minor with the initials of

Drivers License Number

full name of minor

and date of birth

State of Issuance

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full name of additional adult

Social Security Number of second person

Financial Account Number of second person

second minor with the initials of

full name of additional minor

Drivers License Number of second person

and date of birth of second minor

State of Issuance of second person

State Identification Number of second person