Domestic Relations Information Sheet (09-711) at a glance
What it is: The Domestic Relations Information Sheet is for Information on Parent #1 and/or Spouse #1, Parent #2 and/or Spouse #2, Caretaker of Child(ren) other than parents (if any) and Child(ren).
A filled-in Domestic Relations Information Sheet (09-711) example: a parent fills out the first group
How to fill out Domestic Relations Information Sheet (09-711), box by box
Date and Case ID No
Enter the Date and the Case ID No.
Information on Parent #1 and/or Spouse #1
Under Information on Parent #1 and/or Spouse #1, enter First Name, Middle Initial, Last Name and Alias (if any); Interpreter Needed? is Yes (specify type) or No.
Enter the Mailing Address, Residential Address, Email Address, Date of Birth, Social Security No. and DPW No.
Enter Height, Weight, Race, Hair, Eyes and Distinguishing Features.
Enter Place of Employment, Medical Insurance Carrier Name, Address, Home Phone No., Work Phone No., Mobile No., Policy No., Occupation, Salary, Attorney's Name and Address, Attorney ID No. and Attorney Phone No.; Children Covered? is Yes or No.
Information on Parent #2 and/or Spouse #2
Under Information on Parent #2 and/or Spouse #2, enter First Name, Middle Initial, Last Name and Alias (if any); Interpreter Needed? is Yes (specify type) or No.
Under Information on Parent #2 and/or Spouse #2, enter the Mailing Address, Residential Address, Email Address, Date of Birth, Social Security No. and DPW No.
Under Information on Parent #2 and/or Spouse #2, enter Height, Weight, Race, Hair, Eyes and Distinguishing Features.
Under Information on Parent #2 and/or Spouse #2, enter Place of Employment, Medical Insurance Carrier Name, Address, Home Phone No., Work Phone No., Mobile No., Policy No., Occupation, Salary, Attorney's Name and Address, Attorney ID No. and Attorney Phone No.; Children Covered? is Yes or No.
Information if there is a claim for support
Under Information if there is a claim for support, enter DPW No., District Receiving From, Semi-monthly Grant Amount and Total No of People in Household; Receiving Assistance? is Yes or No.
Parties ever married
Parties Ever Married? is Yes or No; enter Marriage Date, Place, Separation Date, Divorce Date and Place.
Maternal Grandmother's Maiden Name and Maternal Grandfather's Name
Enter Maternal Grandmother's Maiden Name and Maternal Grandfather's Name.
Information on caretaker of child(ren) other than parents (if any)
Under Information on Caretaker of Child(ren) other than parents (if any), enter First Name, Middle Initial, Last Name and Alias (if any); Interpreter Needed? is Yes (specify type) or No.
For the caretaker, enter the Mailing Address, Residential Address, Attorney Name/Address/Phone No., Caretaker Email Address, Home Phone No., Work Phone No., Mobile No., Date of Birth and Relationship to children.
Information on child(ren)
Under Information on Child(ren), enter First Name, Middle Initial, Last Name, Gender, Date of Birth, Social Security No. and Place of Birth (City, State); Active on Cash Assistance? is Yes or No.
Under Information on Child(ren), Father Listed on Birth Certificate?, Born Out of Wedlock? and Was Paternity Established? are each Yes or No; enter the Date of Paternity Establishment.
Sources
[1] Domestic Relations Information Sheet, Rev 9/2024, Philadelphia Courts (the Official source link on this page).