G9փqLIu$EG4q' ;l;Vq*)yk`r"`n̆K/Fq>7.r-xPBz>XÈ $EQ@6#|2]Q,M>ۭYh Byb1`/u> r'f80QLS7v!3P ˧<:U56e[2 rv@E(/`uI,LyB P(ڰzg2CjR<Ǥ>CncEUH X[gׇQ,H$sD J2`QpS=gB0N;,.LV٘6eTBm'[=,5L&k0|SZ~z|r)Njԁ:?Q'o,;5o|+9s_:}AzXi~'*pK! \h "I[<Վi2s^Ѻ`:}b+#2RyX)_%yG<)M$3U n#z8O!%Z9C[mհgR[jxʥ\hW֧2~zϙgCbNcD})AJJ<VIrlx ڠ>Fճj+P Y=A͑$hxV}Y^?b=Fo ڰ .7T=޻ &A8`$B/W,]wRQm"wj0f oT^*9lVq*䶀Ok`Sp"n)̆/FGq>7.r,xPBz>XÈ $EQünT|L2=Q,M>ۭYh Byb1`/u> r'f80QLS7v!3P ˧<:U56e[2 rv@E(/`uI,QFʺ P(nZ$'jR<Ǥ>CncEUH X[gׇQ,H$sD J2`QpS=gB0Nظ }{5RTBm'[=P,5yL&q 0|SZzM&Â?gQ߶dUc822g/L>L9^Field4\T CheckBox9 ȷ CheckBox9 x< CheckBox9 |  CheckBox9  which Court? TField21~ TField21T Field21  Field21 L Field21 Field21 LP Field21( Field21)|/ Field21*8 Field21+tD Field21,|Y Field21- o Field210 ComboBox491TField214Field216thField21:<Field21;Field21<Field21?Field21A\Field21CYField21EField21FField21H IField4I!,Field21M"d Field21Q#-Field21R$7Field21S%D@Field21U&LRField21\'Field21](ԩField21^)Field21_*4Field21`+dŲField21a,βField21d-tField21e. ComboBox49h/Field21j0 Field21n1DField21o2MField21p3WField21r4 iField21t5{Field21v6Field21x7$Field21y8TField21{9\Field21|:óField21;Field21<\{Field21=liField21>$)Field21?6Field21@l>Field21ADFField21BNField21C, Field21DField21EField21F" CheckBox9G@9 CheckBox9H(Field21I CheckBox9JC CheckBox9KField21Ld CheckBox9Md CheckBox9NiField21O˴ CheckBox9P CheckBox9QմField21R which Court?S̷Field21TLgField21UܸField21VField21Wȶ CheckBox9X CheckBox9Y8Field21Z$Field21[ԹField21\lַ CheckBox9] CheckBox9^$Field21_O^LPage822HLayer@D'Line200' DG'HLine199G'G D2'26 n Line1982'2 D('( rtLine197('( D9#':# rtLine1969#'9# Dq9#Line195q9# D'4 Rectangle1928'4NOPQ  D'@lLine193'  D /(:Label18/(:  Ld <d"ArialtSerifvqP{\rtf1\ansi\ansicpg1252\deff0\deflang1033{\fonttbl{\f0\fswiss\fprq2\fcharset0 Arial;}} {\colortbl ;\red0\green0\blue0;} \viewkind4\uc1\pard\sl240\slmult1\qc\cf1\b\f0\fs20 MASSACHUSETTS TRIAL COURT\par PROBATE AND FAMILY COURT DEPARTMENT INTAKE REPORT\par } D <KLabel28<K  Ld <d"ArialtSerifvqP/x/x/~x/x/{\rtf1\ansi\ansicpg1252\deff0\deflang1033{\fonttbl{\f0\fswiss\fprq2\fcharset0 Arial;}} {\colortbl ;\red0\green0\blue0;} \viewkind4\uc1\pard\sl240\slmult1\cf1\f0\fs18 PP Case #:\par } D KLabel28K  Ld <d"ArialtSerifvqP/x/x/~x/x/{\rtf1\ansi\ansicpg1252\deff0\deflang1033{\fonttbl{\f0\fswiss\fprq2\fcharset0 Arial;}} {\colortbl ;\red0\green0\blue0;} \viewkind4\uc1\pard\sl240\slmult1\cf1\f0\fs18 Linked Court Cases:\par } D cIField48c  Ld <d"ArialtSerifvqPx/x/ D Label28  Ld <d"ArialtSerifvqP/x/x/~x/x/{\rtf1\ansi\ansicpg1252\deff0\deflang1033{\fonttbl{\f0\fswiss\fprq2\fcharset0 Arial;}} {\colortbl ;\red0\green0\blue0;} \viewkind4\uc1\pard\sl240\slmult1\cf1\f0\fs18 Has there ever been a restraining order in this Case?\par } D ELabel28E  Ld <d"ArialtSerifvqP/x/x/~x/x/{\rtf1\ansi\ansicpg1252\deff0\deflang1033{\fonttbl{\f0\fswiss\fprq2\fcharset0 Arial;}} {\colortbl ;\red0\green0\blue0;} \viewkind4\uc1\pard\sl240\slmult1\cf1\f0\fs18 NO YES\par } D s&Field48s&  Ld 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\viewkind4\uc1\pard\sl240\slmult1\cf1\f0\fs18 Plaintiff / Petitioner / Agency\par } D S$A Label188S$A   Ld <d"ArialtSerifvqP{\rtf1\ansi\ansicpg1252\deff0\deflang1033{\fonttbl{\f0\fswiss\fprq2\fcharset0 Arial;}} {\colortbl ;\red0\green0\blue0;} \viewkind4\uc1\pard\sl240\slmult1\cf1\f0\fs18 Defendant / Co-Petitioner / Subject / Ward\par } D  Label208   Ld <d"ArialtSerifvqP/lx/x/{\rtf1\ansi\ansicpg1252\deff0\deflang1033{\fonttbl{\f0\fswiss\fprq2\fcharset0 Arial;}} {\colortbl ;\red0\green0\blue0;} \viewkind4\uc1\pard\sl240\slmult1\cf1\f0\fs18 Name:\par } D osE which Court?8osE  Ld <d"ArialtSerifvqPx/x/ D 6,   rtLabel2286,    Ld <d"ArialtSerifvqP{\rtf1\ansi\ansicpg1252\deff0\deflang1033{\fonttbl{\f0\fswiss\fprq2\fcharset0 Arial;}} {\colortbl ;\red0\green0\blue0;} \viewkind4\uc1\pard\sl240\slmult1\cf1\f0\fs16 (LAST) (FIRST) (MAIDEN)\par } D   Label208    Ld <d"ArialtSerifvqP/lx/x/{\rtf1\ansi\ansicpg1252\deff0\deflang1033{\fonttbl{\f0\fswiss\fprq2\fcharset0 Arial;}} {\colortbl 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ADDRESS:\par } D Xi4Field218Xi  Ld <d"ArialtSerifvqPx/x/ D 6Field218  Ld <d"ArialtSerifvqPx/x/ D o:Field218o  Ld <d"ArialtSerifvqPx/x/ D Gk >Label208Gk   Ld <d"ArialtSerifvqP/lx/x/{\rtf1\ansi\ansicpg1252\deff0\deflang1033{\fonttbl{\f0\fswiss\fprq2\fcharset0 Arial;}} {\colortbl ;\red0\green0\blue0;} \viewkind4\uc1\pard\sl240\slmult1\cf1\f0\fs18 Other Sources \par of Income: \par } D u ;Field218u   Ld <d"ArialtSerifvqPx/x/ D k @Label208k   Ld <d"ArialtSerifvqP/lx/x/{\rtf1\ansi\ansicpg1252\deff0\deflang1033{\fonttbl{\f0\fswiss\fprq2\fcharset0 Arial;}} {\colortbl ;\red0\green0\blue0;} \viewkind4\uc1\pard\sl240\slmult1\cf1\f0\fs18 Medical Provider:\par } D u <Field218u   Ld <d"ArialtSerifvqPx/x/ D k BLabel208k   Ld <d"ArialtSerifvqP/lx/x/{\rtf1\ansi\ansicpg1252\deff0\deflang1033{\fonttbl{\f0\fswiss\fprq2\fcharset0 Arial;}} {\colortbl ;\red0\green0\blue0;} \viewkind4\uc1\pard\sl240\slmult1\cf1\f0\fs18 Policy #:\par } D ?Field218  Ld <d"ArialtSerifvqPx/x/ D  k <"DLabel208 k <"  Ld <d"ArialtSerifvqP/lx/x/{\rtf1\ansi\ansicpg1252\deff0\deflang1033{\fonttbl{\f0\fswiss\fprq2\fcharset0 Arial;}} {\colortbl ;\red0\green0\blue0;} \viewkind4\uc1\pard\sl240\slmult1\cf1\f0\fs18 Attorney\par } D qAField218q  Ld <d"ArialtSerifvqPx/x/ D AR CField218AR   Ld <d"ArialtSerifvqPx/x/ D !y#GLabel208 !y#  Ld <d"ArialtSerifvqP/lx/x/{\rtf1\ansi\ansicpg1252\deff0\deflang1033{\fonttbl{\f0\fswiss\fprq2\fcharset0 Arial;}} {\colortbl ;\red0\green0\blue0;} \viewkind4\uc1\pard\sl240\slmult1\cf1\f0\fs18 Ph:\par } D  !EField218 !  Ld <d"ArialtSerifvqPx/x/ D !e #FField218!e #  Ld <d"ArialtSerifvqPx/x/ D  JLabel208   Ld <d"ArialtSerifvqP/lx/x/{\rtf1\ansi\ansicpg1252\deff0\deflang1033{\fonttbl{\f0\fswiss\fprq2\fcharset0 Arial;}} {\colortbl ;\red0\green0\blue0;} \viewkind4\uc1\pard\sl240\slmult1\cf1\f0\fs18 Name:\par } D O, % K rtLabel228O, %   Ld <d"ArialtSerifvqP{\rtf1\ansi\ansicpg1252\deff0\deflang1033{\fonttbl{\f0\fswiss\fprq2\fcharset0 Arial;}} {\colortbl ;\red0\green0\blue0;} \viewkind4\uc1\pard\sl240\slmult1\cf1\f0\fs16 (LAST) (FIRST) (MAIDEN)\par } D   LLabel208    Ld <d"ArialtSerifvqP/lx/x/{\rtf1\ansi\ansicpg1252\deff0\deflang1033{\fonttbl{\f0\fswiss\fprq2\fcharset0 Arial;}} {\colortbl ;\red0\green0\blue0;} \viewkind4\uc1\pard\sl240\slmult1\cf1\f0\fs18 Address\par } D "! #HField218"! #  Ld <d"ArialtSerifvqPx/x/ D V ' NLabel208V '   Ld <d"ArialtSerifvqP/lx/x/{\rtf1\ansi\ansicpg1252\deff0\deflang1033{\fonttbl{\f0\fswiss\fprq2\fcharset0 Arial;}} {\colortbl ;\red0\green0\blue0;} \viewkind4\uc1\pard\sl240\slmult1\cf1\f0\fs18 City\par } D  ' OLabel208 '   Ld <d"ArialtSerifvqP/lx/x/{\rtf1\ansi\ansicpg1252\deff0\deflang1033{\fonttbl{\f0\fswiss\fprq2\fcharset0 Arial;}} {\colortbl ;\red0\green0\blue0;} \viewkind4\uc1\pard\sl240\slmult1\cf1\f0\fs18 State\par } D {" $' PLabel208{" $'   Ld <d"ArialtSerifvqP/lx/x/{\rtf1\ansi\ansicpg1252\deff0\deflang1033{\fonttbl{\f0\fswiss\fprq2\fcharset0 Arial;}} {\colortbl ;\red0\green0\blue0;} \viewkind4\uc1\pard\sl240\slmult1\cf1\f0\fs18 Zip\par } D ' MField218'   Ld <d"ArialtSerifvqPx/x/ D  ' QField218 '   Ld <d"ArialtSerifvqPx/x/ D  D RField218 D   Ld <d"ArialtSerifvqPx/x/ D  ;"7TLabel318 ;"7  Ld nsi\<d"ArialtSerifvqPred0\green0\blue0;} \vnd4\uc1\pard\cf1\f0\fs1x/x/x/x/{\rtf1\ansi\ansicpg1252\deff0\deflang1033{\fonttbl{\f0\fswiss\fprq2\fcharset0 Arial;}} {\colortbl ;\red0\green0\blue0;} \viewkind4\uc1\pard\sl240\slmult1\cf1\f0\fs18 MAILING ADDRESS IF DIFFERENT: \par } D |" SField218 |"   Ld <d"ArialtSerifvqPx/x/ D " `VLabel208" `  Ld <d"ArialtSerifvqP/lx/x/{\rtf1\ansi\ansicpg1252\deff0\deflang1033{\fonttbl{\f0\fswiss\fprq2\fcharset0 Arial;}} {\colortbl ;\red0\green0\blue0;} \viewkind4\uc1\pard\sl240\slmult1\cf1\f0\fs18 Home Ph:\par } D "#`WLabel208"#`  Ld <d"ArialtSerifvqP/lx/x/{\rtf1\ansi\ansicpg1252\deff0\deflang1033{\fonttbl{\f0\fswiss\fprq2\fcharset0 Arial;}} {\colortbl ;\red0\green0\blue0;} \viewkind4\uc1\pard\sl240\slmult1\cf1\f0\fs18 Work Ph:\par } D ` XLabel208`   Ld <d"ArialtSerifvqP/lx/x/{\rtf1\ansi\ansicpg1252\deff0\deflang1033{\fonttbl{\f0\fswiss\fprq2\fcharset0 Arial;}} {\colortbl ;\red0\green0\blue0;} \viewkind4\uc1\pard\sl240\slmult1\cf1\f0\fs18 Mobile Ph:\par } D D :#^YLabel208D :#^  Ld <d"ArialtSerifvqP/lx/x/{\rtf1\ansi\ansicpg1252\deff0\deflang1033{\fonttbl{\f0\fswiss\fprq2\fcharset0 Arial;}} {\colortbl ;\red0\green0\blue0;} \viewkind4\uc1\pard\sl240\slmult1\cf1\f0\fs18 Date of Birth:\par } D  ZLabel208   Ld <d"ArialtSerifvqP/lx/x/{\rtf1\ansi\ansicpg1252\deff0\deflang1033{\fonttbl{\f0\fswiss\fprq2\fcharset0 Arial;}} {\colortbl ;\red0\green0\blue0;} \viewkind4\uc1\pard\sl240\slmult1\cf1\f0\fs18 SSN:\par } D y#[Label208y#  Ld <d"ArialtSerifvqP/lx/x/{\rtf1\ansi\ansicpg1252\deff0\deflang1033{\fonttbl{\f0\fswiss\fprq2\fcharset0 Arial;}} {\colortbl ;\red0\green0\blue0;} \viewkind4\uc1\pard\sl240\slmult1\cf1\f0\fs18 DLN:\par } D 8$ ' UField2188$ '   Ld <d"ArialtSerifvqPx/x/ D V '\Field218V '  Ld <d"ArialtSerifvqPx/x/ D P"D3]Field218P"D3  Ld <d"ArialtSerifvqPx/x/ D <""'3^Field218<""'3  Ld <d"ArialtSerifvqPx/x/ D P`Dq_Field218P`Dq  Ld <d"ArialtSerifvqPx/x/ D <"`'q`Field218<"`'q  Ld <d"ArialtSerifvqPx/x/ D  bLabel208   Ld <d"ArialtSerifvqP/lx/x/{\rtf1\ansi\ansicpg1252\deff0\deflang1033{\fonttbl{\f0\fswiss\fprq2\fcharset0 Arial;}} {\colortbl ;\red0\green0\blue0;} \viewkind4\uc1\pard\sl240\slmult1\cf1\f0\fs18 Place of Birth:\par } D !&cLabel208!&  Ld <d"ArialtSerifvqP/lx/x/{\rtf1\ansi\ansicpg1252\deff0\deflang1033{\fonttbl{\f0\fswiss\fprq2\fcharset0 Arial;}} {\colortbl ;\red0\green0\blue0;} \viewkind4\uc1\pard\sl240\slmult1\cf1\f0\fs18 Gender:\par } D DaField218D  Ld <d"ArialtSerifvqPx/x/ D  'dField218 '  Ld <d"ArialtSerifvqPx/x/ D XfLabel208X  Ld <d"ArialtSerifvqP/lx/x/{\rtf1\ansi\ansicpg1252\deff0\deflang1033{\fonttbl{\f0\fswiss\fprq2\fcharset0 Arial;}} {\colortbl ;\red0\green0\blue0;} \viewkind4\uc1\pard\sl240\slmult1\cf1\f0\fs18 FATHER'S NAME:\par } D gLabel208  Ld <d"ArialtSerifvqP/lx/x/{\rtf1\ansi\ansicpg1252\deff0\deflang1033{\fonttbl{\f0\fswiss\fprq2\fcharset0 Arial;}} {\colortbl ;\red0\green0\blue0;} \viewkind4\uc1\pard\sl240\slmult1\cf1\f0\fs18 MOTHER'S NAME:\par } D N}!eField218N}!  Ld <d"ArialtSerifvqPx/x/ D JV)Ti rtLabel538JV)T6\par }   Ld <d"ArialtSerifvqP{\rtf1\ansi\ansicpg1252\deff0\deflang1033{\fonttbl{\f0\fswiss\fprq2\fcharset0 Arial;}} {\colortbl ;\red0\green0\blue0;} \viewkind4\uc1\pard\sl240\slmult1\cf1\f0\fs16 (LAST) (FIRST) (M.I.)\par } D$'h rtComboBox498$'  Ld <d"ArialtSerifvqPMaleFemale D J-)k rtLabel538J-)6\par }   Ld <d"ArialtSerifvqP{\rtf1\ansi\ansicpg1252\deff0\deflang1033{\fonttbl{\f0\fswiss\fprq2\fcharset0 Arial;}} {\colortbl ;\red0\green0\blue0;} \viewkind4\uc1\pard\sl240\slmult1\cf1\f0\fs16 (LAST) (FIRST) (MAIDEN)\par } D  lLabel208   Ld <d"ArialtSerifvqP/lx/x/{\rtf1\ansi\ansicpg1252\deff0\deflang1033{\fonttbl{\f0\fswiss\fprq2\fcharset0 Arial;}} {\colortbl ;\red0\green0\blue0;} \viewkind4\uc1\pard\sl240\slmult1\cf1\f0\fs18 EMPLOYER'S NAME:\par } D  JmLabel208 J  Ld <d"ArialtSerifvqP/lx/x/{\rtf1\ansi\ansicpg1252\deff0\deflang1033{\fonttbl{\f0\fswiss\fprq2\fcharset0 Arial;}} {\colortbl ;\red0\green0\blue0;} \viewkind4\uc1\pard\sl240\slmult1\cf1\f0\fs18 ADDRESS:\par } D X'ijField218X'i  Ld <d"ArialtSerifvqPx/x/ D 'nField218'  Ld <d"ArialtSerifvqPx/x/ D 'oField218'  Ld <d"ArialtSerifvqPx/x/ D GqLabel208G  Ld <d"ArialtSerifvqP/lx/x/{\rtf1\ansi\ansicpg1252\deff0\deflang1033{\fonttbl{\f0\fswiss\fprq2\fcharset0 Arial;}} {\colortbl ;\red0\green0\blue0;} \viewkind4\uc1\pard\sl240\slmult1\cf1\f0\fs18 Other Sources \par of Income: \par } D  'pField218 '  Ld <d"ArialtSerifvqPx/x/ D sLabel208  Ld <d"ArialtSerifvqP/lx/x/{\rtf1\ansi\ansicpg1252\deff0\deflang1033{\fonttbl{\f0\fswiss\fprq2\fcharset0 Arial;}} {\colortbl ;\red0\green0\blue0;} \viewkind4\uc1\pard\sl240\slmult1\cf1\f0\fs18 Medical Provider:\par } D  'rField218 '  Ld <d"ArialtSerifvqPx/x/ D  uLabel208   Ld <d"ArialtSerifvqP/lx/x/{\rtf1\ansi\ansicpg1252\deff0\deflang1033{\fonttbl{\f0\fswiss\fprq2\fcharset0 Arial;}} {\colortbl ;\red0\green0\blue0;} \viewkind4\uc1\pard\sl240\slmult1\cf1\f0\fs18 Policy #:\par } D 'tField218'  Ld <d"ArialtSerifvqPx/x/ D  <"wLabel208 <"  Ld <d"ArialtSerifvqP/lx/x/{\rtf1\ansi\ansicpg1252\deff0\deflang1033{\fonttbl{\f0\fswiss\fprq2\fcharset0 Arial;}} {\colortbl ;\red0\green0\blue0;} \viewkind4\uc1\pard\sl240\slmult1\cf1\f0\fs18 Attorney\par } D 'vField218'  Ld <d"ArialtSerifvqPx/x/ D A'R xField218A'R   Ld <d"ArialtSerifvqPx/x/ D !.)y#zLabel208 !.)y#  Ld <d"ArialtSerifvqP/lx/x/{\rtf1\ansi\ansicpg1252\deff0\deflang1033{\fonttbl{\f0\fswiss\fprq2\fcharset0 Arial;}} {\colortbl ;\red0\green0\blue0;} \viewkind4\uc1\pard\sl240\slmult1\cf1\f0\fs18 Ph:\par } D  '!yField218 '!  Ld <d"ArialtSerifvqPx/x/ D ! #{Field218! #  Ld <d"ArialtSerifvqPx/x/ D 9#w$}Label2089#w$  Ld <d"ArialtSerifvqP/lx/x/{\rtf1\ansi\ansicpg1252\deff0\deflang1033{\fonttbl{\f0\fswiss\fprq2\fcharset0 Arial;}} {\colortbl ;\red0\green0\blue0;} \viewkind4\uc1\pard\sl240\slmult1\cf1\f0\fs18 CHILDREN INVOLVED IN THIS CASE:\par } D t#P 5%~Label1268t#P 5%  Ld <d"ArialtSerifvqP/lx/x/{\rtf1\ansi\ansicpg1252\deff0\deflang1033{\fonttbl{\f0\fswiss\fprq2\fcharset0 Arial;}} {\colortbl ;\red0\green0\blue0;} \viewkind4\uc1\pard\sl240\slmult1\cf1\f0\fs16 NAME\par } D 6$%Label1278 6$%  Ld <d"ArialtSerifvqPx/x/{\rtf1\ansi\ansicpg1252\deff0\deflang1033{\fonttbl{\f0\fswiss\fprq2\fcharset0 Arial;}} {\colortbl ;\red0\green0\blue0;} \viewkind4\uc1\pard\sl240\slmult1\cf1\f0\fs16 BIRTH DATE\par } D 6$G% rtLabel12886$G%  Ld <d"ArialtSerifvqPx/x/{\rtf1\ansi\ansicpg1252\deff0\deflang1033{\fonttbl{\f0\fswiss\fprq2\fcharset0 Arial;}} {\colortbl ;\red0\green0\blue0;} \viewkind4\uc1\pard\sl240\slmult1\cf1\f0\fs16 SOC. SECURITY #:\par } D 6$%G% rtLabel1298 6$%G%  Ld <d"ArialtSerifvqP/lx/x/{\rtf1\ansi\ansicpg1252\deff0\deflang1033{\fonttbl{\f0\fswiss\fprq2\fcharset0 Arial;}} {\colortbl ;\red0\green0\blue0;} \viewkind4\uc1\pard\sl240\slmult1\cf1\f0\fs16 LIVES WITH:\par } D <"!' #|Field218<"!' #  Ld <d"ArialtSerifvqPx/x/ D $&Field218$&  Ld <d"ArialtSerifvqPx/x/ D "$&Field218"$&  Ld <d"ArialtSerifvqPx/x/ D $&Field218$&  Ld <d"ArialtSerifvqPx/x/ D F$q'&Field218F$q'&  Ld <d"ArialtSerifvqPx/x/ D 3&D'Field2183&D'  Ld <d"ArialtSerifvqPx/x/ D "3&D'Field218"3&D'  Ld <d"ArialtSerifvqPx/x/ D 3&D'Field2183&D'  Ld <d"ArialtSerifvqPx/x/ D E3&p'D'Field218E3&p'D'  Ld <d"ArialtSerifvqPx/x/ D q'(Field218q'(  Ld <d"ArialtSerifvqPx/x/ D "q'(Field218"q'(  Ld <d"ArialtSerifvqPx/x/ D q'(Field218q'(  Ld <d"ArialtSerifvqPx/x/ D )|+Label1428)|+  Ld <d"ArialtSerifvqP{\rtf1\ansi\ansicpg1252\deff0\deflang1033{\fonttbl{\f0\fswiss\fprq2\fcharset0 Arial;}} {\colortbl ;\red0\green0\blue0;} \viewkind4\uc1\pard\sl240\slmult1\cf1\f0\fs18 CARI? NO YES PCF:\par } D Eq'p'(Field218Eq'p'(  Ld <d"ArialtSerifvqPx/x/D7)b+ CheckBox987)b+  4  D)+ CheckBox98)+  4  D (? ) rtLabel1468(? )  Ld <d"ArialtSerifvqPx/x/x/c{\rtf1\ansi\ansicpg1252\deff0\deflang1033{\fonttbl{\f0\fswiss\fprq2\fcharset0 Arial;}} {\colortbl ;\red0\green0\blue0;} \viewkind4\uc1\pard\sl240\slmult1\cf1\f0\fs16 *ADDITIONAL INFORMATION*\par } D )'<+Label1428)'<+  Ld <d"ArialtSerifvqP{\rtf1\ansi\ansicpg1252\deff0\deflang1033{\fonttbl{\f0\fswiss\fprq2\fcharset0 Arial;}} {\colortbl ;\red0\green0\blue0;} \viewkind4\uc1\pard\sl240\slmult1\cf1\f0\fs18 CARI? NO YES PCF:\par } D )W*Field218 )W*  Ld <d"ArialtSerifvqPx/x/D)+ CheckBox98)+  4  DK)v+ CheckBox98K)v+  4  D )+,Label1428)+,  Ld <d"ArialtSerifvqP{\rtf1\ansi\ansicpg1252\deff0\deflang1033{\fonttbl{\f0\fswiss\fprq2\fcharset0 Arial;}} {\colortbl ;\red0\green0\blue0;} \viewkind4\uc1\pard\sl240\slmult1\cf1\f0\fs18 WMS? NO YES PCF:\par } D )p'*Field218)p'*  Ld <d"ArialtSerifvqPx/x/D7i+b, CheckBox987i+b,  4  Di+, CheckBox98i+,  4  D )+',Label1428)+',  Ld <d"ArialtSerifvqP{\rtf1\ansi\ansicpg1252\deff0\deflang1033{\fonttbl{\f0\fswiss\fprq2\fcharset0 Arial;}} {\colortbl ;\red0\green0\blue0;} \viewkind4\uc1\pard\sl240\slmult1\cf1\f0\fs18 WMS? NO YES PCF:\par } D i+Wz,Field218 i+Wz,  Ld <d"ArialtSerifvqPx/x/Di+, CheckBox98i+,  4  DKi+v, CheckBox98Ki+v,  4  D 4Label284  Ld <d"ArialtSerifvqP/x/x/~x/x/{\rtf1\ansi\ansicpg1252\deff0\deflang1033{\fonttbl{\f0\fswiss\fprq2\fcharset0 Arial;}} {\colortbl ;\red0\green0\blue0;} \viewkind4\uc1\pard\sl240\slmult1\cf1\f0\fs18 Against Whom?\par } D i+p'z,Field218i+p'z,  Ld <d"ArialtSerifvqPx/x/ D ,/- rtLabel1468,/-  Ld <d"ArialtSerifvqPx/x/x/c{\rtf1\ansi\ansicpg1252\deff0\deflang1033{\fonttbl{\f0\fswiss\fprq2\fcharset0 Arial;}} {\colortbl ;\red0\green0\blue0;} \viewkind4\uc1\pard\sl240\slmult1\cf1\f0\fs18 Date of Marriage:\par } D 1,-Field2181,-  Ld <d"ArialtSerifvqPx/x/ D %-#. rtLabel1468%-#.  Ld <d"ArialtSerifvqPx/x/x/c{\rtf1\ansi\ansicpg1252\deff0\deflang1033{\fonttbl{\f0\fswiss\fprq2\fcharset0 Arial;}} {\colortbl ;\red0\green0\blue0;} \viewkind4\uc1\pard\sl240\slmult1\cf1\f0\fs18 Date of Separation:\par } D #./!/ rtLabel1468#./!/  Ld <d"ArialtSerifvqPx/x/x/c{\rtf1\ansi\ansicpg1252\deff0\deflang1033{\fonttbl{\f0\fswiss\fprq2\fcharset0 Arial;}} {\colortbl ;\red0\green0\blue0;} \viewkind4\uc1\pard\sl240\slmult1\cf1\f0\fs18 Date of Divorce:\par } D #.!/ rtLabel1468#.!/  Ld <d"ArialtSerifvqPx/x/x/c{\rtf1\ansi\ansicpg1252\deff0\deflang1033{\fonttbl{\f0\fswiss\fprq2\fcharset0 Arial;}} {\colortbl ;\red0\green0\blue0;} \viewkind4\uc1\pard\sl240\slmult1\cf1\f0\fs18 Date of Adjudication:\par } D ,v$-Field218,v$-  Ld <d"ArialtSerifvqPx/x/ D 1#.4/Field2181#.4/  Ld <d"ArialtSerifvqPx/x/ D #.v$4/Field218#.v$4/  Ld <d"ArialtSerifvqPx/x/ D !/k 0\p Label1728!/k 0  Ld <d"ArialtSerifvqP{\rtf1\ansi\ansicpg1252\deff0\deflang1033{\fonttbl{\f0\fswiss\fprq2\fcharset0 Arial;}} {\colortbl ;\red0\green0\blue0;} \viewkind4\uc1\pard\sl240\slmult1\cf1\f0\fs16 AGENCY INVOLVEMENT:\par } D _0 ]1Label1738_0 ]1  Ld <d"ArialtSerifvqP/{\rtf1\ansi\ansicpg1252\deff0\deflang1033{\fonttbl{\f0\fswiss\fprq2\fcharset0 Arial;}} {\colortbl ;\red0\green0\blue0;} \viewkind4\uc1\pard\sl240\slmult1\cf1\f0\fs18 DOR YES NO\par } D40_J1 CheckBox9840_J1  4  Dm 0 J1 CheckBox98m 0 J1  4  D ]1 [2Label1738]1 [2  Ld <d"ArialtSerifvqP/{\rtf1\ansi\ansicpg1252\deff0\deflang1033{\fonttbl{\f0\fswiss\fprq2\fcharset0 Arial;}} {\colortbl ;\red0\green0\blue0;} \viewkind4\uc1\pard\sl240\slmult1\cf1\f0\fs18 GAL YES NO\par } D & _0[]1Label1738& _0[]1  Ld <d"ArialtSerifvqP/{\rtf1\ansi\ansicpg1252\deff0\deflang1033{\fonttbl{\f0\fswiss\fprq2\fcharset0 Arial;}} {\colortbl ;\red0\green0\blue0;} \viewkind4\uc1\pard\sl240\slmult1\cf1\f0\fs18 Agency \par } D a001Field218a001  Ld <d"ArialtSerifvqPx/x/ D K001Field218K001  Ld <d"ArialtSerifvqPx/x/ D !01'01Field218!01'01  Ld <d"ArialtSerifvqPx/x/D4]1_2 CheckBox984]1_2  4  Dm ]1 2 CheckBox98m ]1 2  4  D & ]1W[2 rtLabel1468& ]1W[2  Ld <d"ArialtSerifvqPx/x/x/c{\rtf1\ansi\ansicpg1252\deff0\deflang1033{\fonttbl{\f0\fswiss\fprq2\fcharset0 Arial;}} {\colortbl ;\red0\green0\blue0;} \viewkind4\uc1\pard\sl240\slmult1\cf1\f0\fs18 Office:\par } D a]1q'n2Field218a]1q'n2  Ld <d"ArialtSerifvqPx/x/ D 03c4 rtLabel146803c4  Ld <d"ArialtSerifvqPx/x/x/c{\rtf1\ansi\ansicpg1252\deff0\deflang1033{\fonttbl{\f0\fswiss\fprq2\fcharset0 Arial;}} {\colortbl ;\red0\green0\blue0;} \viewkind4\uc1\pard\sl240\slmult1\cf1\f0\fs18 PO Signature:\par } D 3;"4 rtLabel14683;"4  Ld <d"ArialtSerifvqPx/x/x/c{\rtf1\ansi\ansicpg1252\deff0\deflang1033{\fonttbl{\f0\fswiss\fprq2\fcharset0 Arial;}} {\colortbl ;\red0\green0\blue0;} \viewkind4\uc1\pard\sl240\slmult1\cf1\f0\fs18 Date:\par } Dg 33Line187g 33 D3$3Line1883$3  D '2+*j4Label1898'2+*j4x/x/  Ld <d"ArialtSerifvqP/x/x/x/{\rtf1\ansi\ansicpg1252\deff0\deflang1033{\fonttbl{\f0\fswiss\fprq2\fcharset0 Arial;}} {\colortbl ;\red0\green0\blue0;} \viewkind4\uc1\pard\sl240\slmult1\cf1\f0\fs16 c.g.f.\par } D _0C]1Label1738_0C]1  Ld <d"ArialtSerifvqP/{\rtf1\ansi\ansicpg1252\deff0\deflang1033{\fonttbl{\f0\fswiss\fprq2\fcharset0 Arial;}} {\colortbl ;\red0\green0\blue0;} \viewkind4\uc1\pard\sl240\slmult1\cf1\f0\fs18 Ph\par } D _07$]1Label1738_07$]1  Ld <d"ArialtSerifvqP/{\rtf1\ansi\ansicpg1252\deff0\deflang1033{\fonttbl{\f0\fswiss\fprq2\fcharset0 Arial;}} {\colortbl ;\red0\green0\blue0;} \viewkind4\uc1\pard\sl240\slmult1\cf1\f0\fs18 Worker\par } Dq'rLine194q'q