Person Filing: Address (if not protected): City, State, Zip Code: Telephone: Email Address: ATLAS Number: Lawyer222s Bar Number: Representing Self, without a Lawyer or Attorney for Petitioner OR Respondent SUPERIOR COURT OF ARIZONA IN MARICOPA COUNTY Leave Blank. For Court Use Only. Petitio ner (in o ut - of - state case) Arizona Superior Court Case Number AFFIDAVIT REGARDING MINOR CHILDREN to REGISTER FOREIGN CUSTODY ORDER under the Uniform Child Custody Jurisdiction Enforcement Act (UCCJEA) (A.R.S. 247 25-1039) Responden t (in o ut - of - state case) UNDER OATH OR AFFIRMATION 1.FIVE (5) YEAR RESIDENTIAL HISTORY FOR EACH MINOR, or since birth, for childyounger than five: (Enter Birthdate as Month/Date/Year. Enter 223M224 for male, 223F224 for Female.) For Clerk222s Use Only Note: If specific address or identifying information would endanger a party or child and the information is not already known to other parties, write 223Protected224 in the space for that information and supply it to the court on the 223Request for Protected Address224 form available from any Law Library Resource Center location or at its website. 251 Superior Court of Arizona in Maricopa County DRFOC13f-031418 ALL RIGHTS RESERVED Page 1 of 5 American LegalNet, Inc. www.FormsWorkFlow.com Case No. A. Child222s Name Place of Birth Birthdate Sex Where Lived for Past 5 Years (City & State) From / To (Month/Year) Name of Person Child Lived With AND that Person222s Current Address to to to to B. Child222s Name Place of Birth Birthdate Sex Where Lived for Past 5 Years (City & State) From / To (Month/Year) Name of Person Child Lived With AND that Person222s Current Address to to to to C. Child222s Name Place of Birth Birthdate Sex Where Lived for Past 5 Years (City & State) From / To (Month/Year) Name of Person Child Lived With AND that Person222s Current Address to to 251 Superior Court of Arizona in Maricopa County DRFOC13f- ALL RIGHTS RESERVED Page 2 of 5 American LegalNet, Inc. www.FormsWorkFlow.com Case No. to to Information about additional children continues on included pages made part of this document. 2.Other than the case which issued the order you are seeking to register, haveyou participated as a party, a witness or otherwise, in any matter that addressedyour custody, visitation, or parenting time, with the minor children listed above? YES NO (If you have, explain below. IF NO, GO TO #3) Case Number: Family Law Guardianship Other: Children involved: Name of Court: State which issued Order: Type of Proceeding: Case Status: Dismissed Pending Order Signed (date) : Court Decision : Continues on additional pages included and made part of this document. 3.Other than the case which issued the order you are seeking to register, do youknow of any matter concerning domestic violence, protective order,termination of parental rights and adoptions involving any of the parties inthe case which issued the order you are seeking to register? YES NO (If you know of such matters, explain below. IF NO, GO TO #4.) 251 Superior Court of Arizona in Maricopa County DRFOC13f- ALL RIGHTS RESERVED Page 3 of 5 American LegalNet, Inc. www.FormsWorkFlow.com Case No. Children involved: Name of Court/Agency: Case Number : State which issued Order : Type of Proceeding: (Describe briefly) Case Status: Dismissed Pending Order Signed (date): Court Decision or Agency Action (if any) : Continues on additional pages included and made part of this document. 4.Do you know of any person, other than the one named in the order you areseeking to register, who has physical custody of or visitation with the childrenlisted above? YES NO (If you know of such person(s), explain below.) Name of Person Claiming Custody or Visitation : Complete Address: Basis of Claim: ( Why this person believes he or she has rights concerning the child(ren)) 251 Superior Court of Arizona in Maricopa County DRFOC13f- ALL RIGHTS RESERVED Page 4 of 5 American LegalNet, Inc. www.FormsWorkFlow.com Case No. Children Involved (Names) : Continues on additional pages included and made part of this document. OATH OR AFFIRMATION By signing below, I swear or affirm under penalty of perjury that the contents of this document are true and correct to the best of knowledge and belief. Signature of Person Sending Documents Date STATE OF COUNTY OF Subscribed and sworn to or affirmed before me this: by (date) . (notary seal) Deputy Clerk or Notary Public 251 Superior Court of Arizona in Maricopa County DRFOC13f- ALL RIGHTS RESERVED Page 5 of 5 American LegalNet, Inc. www.FormsWorkFlow.com