Person Filing: Mailing Address: City, State, Zip Code: Daytime / Evening Phone: In this case I am a: Petitioner or a Attorney Name: Attorney Phone: ATLAS No. (if applicable): / Respondent Represented by Attorney Bar No.: Atty. Email: FOR CLERK’S USE ONLY SUPERIOR COURT OF ARIZONA IN MARICOPA COUNTY Case Number: Name of Petitioner Current Judge: PETITION FOR PRE-DECREE MEDIATION Name of Respondent We do not agree about the custody and/or parenting-time issues involving our child(ren) and I ask that Conciliation Services set a mediation of the issues, based on the following: 1. Check one box only. Divorce Pending: My spouse or I have filed papers with the Court for divorce or legal separation. No final orders about legal custody or parenting time have been entered by the Judge. OR Paternity Pending: The Father or Mother has filed papers with this Court to establish paternity of the child(ren). No final orders about legal custody or parenting time have been entered by the Judge. OR Other (describe): 2. Check one box only. 3. Describe the disagreement. Be brief and specific. (The disagreement must involve the custody and/or parenting time of your minor children): 4. Information About Other Party: Name: Address: City, State, Zip code: Telephone Number(s): Attorney (if known): We have not participated in mediation OR We have participated in mediation before. / Date : Signature of Person Submitting Motion for Mediation NOTICE TO BOTH PARTIES: If your order is signed by the Judicial Officer, Conciliation Services will mail an “Order to Attend Mediation” to both parties. WARNING: FAILURE TO ATTEND CARRIES A $200 FEE. DRADM11f ©Superior Court of Arizona in Maricopa County August 13, 2007 ALL RIGHTS RESERVED PTT Page 1 of 1 Use most current version American LegalNet, Inc. www.FormsWorkflow.com