20.B Affidavit in Support of Good Cause Request


Custodial Parent

Non-Custodial Parent

Wyoming Case Number

I, _______________, hereby swear under penalty of perjury that I believe that pursuing child support services will put me and/or my children at risk of physical or emotional harm. I have been offered the following safety measures:

  • Phone appearance so that I do not have to appear in courtroom with other party

  • Separate meetings with child support so that I do not have to meet with the other party in person

  • Assistance and support from the local domestic violence program.

  • Family Violence Indicator (Preventing my address information from being disclosed by Child Support)

  • Confidentiality order (Preventing the Court from releasing my address information)

Understanding that I have the right to avail myself of the above protections, I still wish to claim good cause because: (check all that apply)

Accessing paternity establishment/child support services will:

Put me at risk of physical harm Put me at risk of emotional harm

Put the child(ren) at risk of physical harm Put the child(ren) at risk of emotional harm


Legal proceedings for the child’s adoption are pending before a court.

Child was conceived as a result of sexual assault or sexual abuse of a minor.

I am being assisted by a social service agency to decide whether to keep my child or relinquish him/her for adoption.

______________________________________ ________________________

Signature Date

Cross Reference


Version Number


Last Revised Date

May 1, 2022