Name of Person Filing: In this case I am: Petitioner Respondent In this case I am: Representing Myself (No Attorney), or If Represented by Attorney: Attorney Bar Number: My Address (if not protected): City, State, Zip Code: Telephone Numbers: ATLAS Number (if applicable): FOR CLERK’S USE ONLY SUPERIOR COURT OF ARIZONA IN MARICOPA COUNTY Case Number: Name of Petitioner PETITION FOR LEGAL SEPARATION WITH MINOR CHILDREN AND Name of Respondent STATEMENTS MADE TO THE COURT, UNDER OATH OR AFFIRMATION: GENERAL INFORMATION: 1. INFORMATION ABOUT ME, THE PETITIONER Name: Address: Date of Birth: Job Title: I have lived in Arizona for 2. months in a row. INFORMATION ABOUT, MY SPOUSE, THE RESPONDENT: Name: Address: Date of Birth: Job Title: Respondent has lived in Arizona for 3. years and/or years and/or months in a row. INFORMATION ABOUT MY MARRIAGE: Date of Marriage: City and state, or country where we were married: 4. CHILDREN OF THE PARTIES WHO ARE LESS THAN 18 YEARS OLD (check one box): There are no children under the age of 18 either born to, or adopted by, the parties. NOTE: IF YOU CHECKED THIS BOX, STOP. YOU SHOULD BE USING THE PETITION PACKET TO GET A LEGAL SEPARATION WITHOUT CHILDREN. The following child(ren) are under age 18 and were born to or adopted by my spouse and me: (Attach extra pages if necessary). ©Superior Court of Arizona in Maricopa County July 1, 2008 ALL RIGHTS RESERVED COM DRLSC10f Use only most current version Page 1 of 7 American LegalNet, Inc. www.FormsWorkflow.com Case No. Child’s Name: Birthdate: Address: Length of Time at Address: Child’s Name: Birthdate: Address: Length of Time at Address: Child’s Name: Birthdate: Address: Length of Time at Address: Child’s Name: Birthdate: Address: Length of Time at Address: 5. RESIDENCY REQUIREMENT. When I file this document with the Court, either 6. DESIRE TO LIVE SEPARATE AND APART. My marriage is irretrievably broken (my marriage I or my spouse live or are stationed while a member of the Armed Forces, in Arizona. (WARNING: If this statement is not true, you cannot file for legal separation until it becomes true.) is over) or I and/or my spouse desire to live separate and apart. (This must be a true statement or you cannot file for a Petition for Legal Separation.) 7. DOMESTIC VIOLENCE. (If you intend to ask for joint custody, there must have been no “significant” domestic violence in your marriage. A.R.S. 25-403.03. Check the box that makes a true statement): Significant domestic violence has OR has not occurred during this marriage. 8. PREGNANCY. Wife is not pregnant, OR Wife is pregnant (date), (and, check one box below): The baby is due on The Petitioner and Respondent are the parents of the child, OR Petitioner is not the parent of the child, OR. Respondent is not the parent of the child. 9. SPOUSAL MAINTENANCE (ALIMONY). (Check the box that applies to you): Neither party is entitled to Spousal Maintenance (alimony), OR Petitioner OR Respondent is entitled to Spousal Maintenance because: (Check one or more of the box(es) below that apply. At least one reason must apply to get spousal maintenance.) Person lacks sufficient property to provide for his or her reasonable needs; Person is unable to support himself or herself through appropriate employment; Person is the custodian of a child(ren) whose age or condition is such that the person should not be required to seek employment outside the home; Person lacks earning ability in the labor market adequate to support himself or herself; and, Person contributed to the educational opportunities of the other spouse or had a marriage of long duration and is now of an age that precludes the possibility of gaining employment adequate to support himself or herself. ©Superior Court of Arizona in Maricopa County DRLSC10f July 1, 2008 ALL RIGHTS RESERVED COM Use only most current version Page 2 of 7 American LegalNet, Inc. www.FormsWorkflow.com Case No. INFORMATION ABOUT PROPERTY AND DEBTS: 10(a) PROPERTY ACQUIRED DURING THE MARRIAGE. (Check one box) My spouse and I did not acquire community property during the marriage, OR My spouse and I acquired community property during our marriage, and we should divide it as follows: (List the property and the value of the property, and check the box to tell the Court who should get the property.) WARNING: You must be specific. You must describe the property that should go to you and then check the box, and describe the property that should go to your spouse, and check the box. For example, under household furnishings you could say, blue and white living room sofa, and then check the box to say whether it should go to you or to your spouse. Never list an item and then check both the Petitioner box and the Respondent box. You, Petitioner Your Spouse Value DESCRIPTION OF PROPERTY/ (Respondent) VALUE OF PROPERTY: Real estate at: $ Legal Description: Real estate at: $ Legal Description: Household furniture and appliances: $ $ $ $ $ $ $ Household furnishings: $ $ $ $ $ $ Other items: $ $ $ $ ©Superior Court of Arizona in Maricopa County July 1, 2008 ALL RIGHTS RESERVED COM DRLSC10f Use only most current version Page 3 of 7 American LegalNet, Inc. www.FormsWorkflow.com Case No. You, Petitioner Pension/retirement fund/profit sharing / stock plan/401K: Your Spouse (Respondent) Value $ $ $ DESCRIPTION OF PROPERTY/ You, Petitioner Motor vehicles: Make Model VIN Lien Holder Year_____ Make Model VIN Lien Holder Your Spouse (Respondent) Value $ $ Year_____ 10(b) PROPERTY ACQUIRED BEFORE MARRIAGE. (Check all boxes that apply.) I do not have any property that I brought into the marriage (separate property). My spouse, the Respondent does not have any property that he or she brought into the marriage. (separate property). I have property that I brought into the marriage (separate property). I want this property awarded to me as described below. My spouse, the Respondent, has property that he or she brought into the marriage. I want this property awarded to my spouse as described below. Separate Property: (List the property and the value of the property, and check the box to tell the Court who should get the property.) DESCRIPTION OF PROPERTY/ You, Petitioner Your Spouse, Respondent) Value $ $ $ $ $ $ $ 11(a) DEBTS INCURRED DURING THE MARRIAGE. (check one box) My spouse and I did not incur any community debts during the marriage, OR We should divide the responsibility for the community debts incurred during the marriage as follows: ©Superior Court of Arizona in Maricopa County July 1, 2008 ALL RIGHTS RESERVED COM DRLSC10f Use only most current version Page 4 of 7 American LegalNet, Inc. www.FormsWorkflow.com Case No. DESCRIPTION OF DEBT You, Petitioner Your Spouse, (Respondent) Amount $ $ $ $ $ $ $ $ 11(b) SEPARATE DEBTS. (Check all boxes that apply.) My spouse and I do not have any debts that were incurred prior to the marriage, OR I have separate debt that I incurred prior to the marriage which should be paid by me as described below: My spouse has separate debt that he or she incurred prior to the marriage which should be paid by my spouse as described below: DESCRIPTION OF DEBT You, Petitioner Your Spouse, (Respondent) Amount $ $ $ $ $ $ 12. TAX RETURNS. After the Judge or Commissioner signs the Order of Legal Separation, the parties will file state and federal taxes as follows: 13. WRITTEN AGREEMENT. CHECK ONLY IF TRUE: My spouse and I have a written agreement signed by both of us about the maintenance of a spouse, division of property/debt, custody, parenting time, and child support for our child(ren), and I have attached a copy of the written agreement. OTHER STATEMENTS TO THE COURT UNDER OATH OR AFFIRMATION: You must tell the court the truth. Lying to the court is a crime and the court can punish you for lying. To file for legal separation, you must be able to tell the Court that the following statements are true. If the statements are not true, you cannot file for legal separation until the statements are true. Check the box in front of each statement if the statement is true. If you do not understand what the statements mean, read the instructions that go along with the Petition for Legal Separation. 14. TRUE The conciliation requirements under Arizona law either do not apply or have been met. 15. TRUE This court has jurisdiction to decide child custody matters under Arizona law. ©Superior Court of Arizona in Maricopa County July 1, 2008 ALL RIGHTS RESERVED COM DRLSC10f Use only most current version Page 5 of 7 American LegalNet, Inc. www.FormsWorkflow.com Case No. REQUESTS TO THE COURT: A. LEGAL SEPARATION: An order of legal separation. B. Order spousal support to be paid by Petitioner, or Respondent in the amount of $ per month beginning with the first day of the month after the Judicial Officer signs the Decree and continuing until the person receiving spousal maintenance is remarried or deceased, or for a period of months. These payments, and a fee for handling, will be paid through the Support Payment Clearinghouse. C. COMMUNITY PROPERTY: Make a fair division of all community property as requested in this Petition. D. COMMUNITY DEBTS: Order each party to pay community debts as requested in the Petition, and to pay any other community debts unknown to the other party. Order each party to pay and hold the other party harmless from debts incurred by him or her since the parties separation on (date): . E. SEPARATE PROPERTY: Award each party his or her separate property. F. CHILD CUSTODY AND PARENTING TIME: Award custody and parenting time of the children common to the parties, and less than 18 years as follows: (Check either the sole custody box or the joint custody box. If you check the sole custody box, check only one box related to parenting time.) F.1. SOLE CUSTODY. Mother is awarded the sole custody of and/or Father is awarded the sole custody of subject to parenting time as follows: Reasonable parenting time rights to the parent, who does not have custody, as will be described in the Parenting Plan attached to the Order of Legal Separation. OR Reasonable parenting time rights to the parent who does not have custody pursuant to the Maricopa County Parent Access/Parenting time Guidelines. Supervised parenting time between the children and Mother OR Father is in the best interest of the children because: (Explain the reasons for supervision or no parenting time. Use extra paper if necessary.), a. b. Name of the person who will supervise: Requested restrictions on parenting time: (explain here) c. The cost of supervised parent/child parenting time will be paid by the parent the parent having custody; shared equally by the parties. being supervised No parenting time rights to the parent who does not have custody is in the best interests of the child(ren) because: (Explain the reasons for no parenting time. Use extra paper if necessary): OR ©Superior Court of Arizona in Maricopa County July 1, 2008 ALL RIGHTS RESERVED COM DRLSC10f Use only most current version Page 6 of 7 American LegalNet, Inc. www.FormsWorkflow.com Case No. F.2. JOINT CUSTODY. Mother and Father agree to act as joint custodians of the minor child(ren) as set forth in the Parenting Plan signed by the parties, if the Court agrees with the Parenting Plan. (For joint custody, there must have been no “significant” domestic violence. A.R.S. 25403.03) G. CHILD SUPPORT: Order that child support will be paid by: Mother OR Father in a reasonable amount as determined by the Court under the Arizona Child Support Guidelines. (I will attach the Child Support Order to the Decree). Support payments will begin on the first day of the first month following the entry of the decree. These payments, and a fee for handling, will be paid through the Support Payment Clearinghouse and collected by automatic wage assignment. H. MEDICAL, DENTAL, VISION CARE FOR MINOR CHILDREN: Order that Petitioner is responsible for providing: Respondent is responsible for providing: medical medical dental dental vision care insurance. vision care insurance. Mother and Father will pay for all reasonable unreimbursed medical, dental, and health-related expenses incurred for the child(ren) in proportion to their respective incomes as described in the Parents' Worksheet, which I will submit with the Decree. I. TAX EXEMPTION: The parties will claim the minor children as income tax dependency exemptions on federal and state income tax returns as follows: Parent entitled to claim Mother Mother Mother Mother J. Name of child Current tax year Later tax years Father Father Father Father OTHER ORDERS I AM REQUESTING (Explain request here): OATH OR AFFIRMATION The contents of this document are true and correct to the best of my knowledge and belief. Signature Date Sworn to or affirmed before me this date: Seal/My Commission expires ©Superior Court of Arizona in Maricopa County July 1, 2008 ALL RIGHTS RESERVED COM Deputy Clerk or Notary DRLSC10f Use only most current version Page 7 of 7 American LegalNet, Inc. www.FormsWorkflow.com