Name: Representing: Self Petitioner Respondent (If Attorney) State Bar Number: SUPERIOR COURT OF ARIZONA IN MARICOPA COUNTY FOR CLERK’S USE ONLY Case No. Petitioner ATLAS No. Respondent FAMILY COURT /SENSITIVE DATA COVERSHEET WITHOUT CHILDREN (CONFIDENTIAL RECORD) Fill out. File with Clerk of Court. Social Security Numbers should appear on this form only and should be omitted from other court forms. Access Confidential pursuant to ARFLAP 43(G)(1). A. Personal Information: Name Gender Petitioner Male or Female Respondent Male or Female Date of Birth (Month/Day/Year) Social Security Number WARNING: DO NOT INCLUDE MAILING ADDRESS ON THIS FORM IF REQUESTING ADDRESS PROTECTION Mailing Address City, State, Zip Code Contact Phone Email Address Current Employer Name Employer Address Employer City, State, Zip Code Employer Telephone Number Employer Fax Number Type of Case being filed - Check only one category. *Check only if no other category applies Interpreter Needed: Yes No Dissolution (Divorce) B. If yes, what language(s)? Legal Separation Annulment Order of Protection Other* © Superior Court of Arizona in Maricopa County ALL RIGHTS RESERVED DRSDS10f-A-120910 Page 1 of 1 American LegalNet, Inc. www.FormsWorkFlow.com