Arizona Supreme Court Page 1 of 6 DRES11F-090617 (1) Person Filing : Address (if not protected): City, State, Zip Code: Telephone : Email Address : ATLAS Number : Representing [ ] Self, or [ ] Lawyer for Lawyer222s Bar Number : SUPERIOR COURT OF ARIZONA IN COUNTY (2) Petitioner vs. (2) Respondent Case Number : (3) PETITION TO ESTABLISH CHILD SUPPORT 1. INFORMATION ABOUT ME: Name: Address: City, State, Zip Code: County of Residence: Birth Date: Occupation: My relationship to child(ren) listed in this petition: [ ] I am the Mother [ ] I am the Father [ ] Other: (Explain) 2. INFORMATION ABOUT THE OTHER PARTY: Name: Address: City, State, Zip Code: For Clerk222s Use Only American LegalNet, Inc. www.FormsWorkFlow.com Case Number: Arizona Supreme Court Page 2 of 6 DRES11F-090617 County of Residence: Birth Date: Occupation: Other party222s relationship to child(ren) listed in this petition: [ ] Other party is the Mother [ ] Other party is the Father [ ] Other: (Explain) 3. VENUE: [ ] This is the proper court to bring this lawsuit under Arizona law because it is the county of residence of the minor child(ren) or the party filing this Petition if the minor child(ren) resides outside of Arizona and there is no prior court order involving the child(ren) listed in this Petition. 4. JURISDICTION. This Court has jurisdiction under A.R.S. 247 25-502 to order a party to pay child support because: [ ] The other Party is a resident of Arizona. [ ] I believe that I will personally serve the other Party in Arizona. [ ] The other Party agrees to have the case heard here and will file written papers in the court case. [ ] The other Party lived with the minor child(ren) in this state at some time. [ ] The other Party lived in this state and provided pre-birth expenses or support for the minor child(ren). [ ] The minor child(ren) lives in this state as a result of the acts or directions of the other Party. 5. INFORMATION ABOUT THE MINOR CHILDREN A. Child222s Name : Birth Date: Gender: [ ] Female [ ] Male Place of Birth: Current Address : City, State, Zip Code : County: Length of Time at Address : American LegalNet, Inc. www.FormsWorkFlow.com Case Number: Arizona Supreme Court Page 3 of 6 DRES11F-090617 Lived with [ ] Mother [ ] Father [ ] Other (Name & Relation to Child): B. Child222s Name : Birth Date: Gender: [ ] Female [ ] Male Place of Birth: Current Address : City, State, Zip Code : County: Length of Time at Address : Lived with [ ] Mother [ ] Father [ ] Other (Name & Relation to Child): C. Child222s Name : Birth Date: Gender: [ ] Female [ ] Male Place of Birth: Current Address : City, State, Zip Code : County: Length of Time at Address : Lived with [ ] Mother [ ] Father [ ] Other (Name & Relation to Child): D. Child222s Name : Birth Date: Gender: [ ] Female [ ] Male Place of Birth: Current Address : City, State, Zip Code : County: Length of Time at Address : Lived with [ ] Mother [ ] Father [ ] Other (Name & Relation to Child): [ ] Information for additional children is listed on attached page(s), made part of this document. American LegalNet, Inc. www.FormsWorkFlow.com Case Number: Arizona Supreme Court Page 4 of 6 DRES11F-090617 6. PATERNITY. Paternity was established by: (Check one box.) [ ] A court Order for Paternity from this county or previously transferred to this county stating that is the natural Father of the minor child(ren) included in this Petition. (A.R.S. 247 25-502(c)) [ ] Both parents signing an Acknowledgment of Paternity through the Hospital Paternity Program or other means provided by law after July 18, 1996, and a birth certificate listing the name of the Father was issued as a result. [ ] Parties were legally married when child(ren) was (were) born, conceived, or adopted. 7. CHILD SUPPORT FOR MINOR CHILD(REN). (Check one box.) [ ] To my knowledge there is no child support order for the minor child(ren) and the Court should order child support in this case. [ ] [ ] Petitioner [ ] Respondent made voluntary / direct support payments that need to be taken into account, if past support is requested. [ ] [ ] Petitioner [ ] Respondent owes past support for the period between: [ ] the date this petition was filed, and the date current child support is ordered. OR [ ] the date the parties started living apart, but not more than three years before the date this petition was filed, and the date current child support is ordered. [ ] I am providing support for or have physical custody of the following child(ren): Name (first , middle, last) Date of Birth The other party is the natural or adoptive parent of the child(ren) listed above and has a legal duty to provide support pursuant to A.R.S. 247 25-501. American LegalNet, Inc. www.FormsWorkFlow.com Case Number: Arizona Supreme Court Page 5 of 6 DRES11F-090617 REQUESTS TO THE COURT. A. CHILD SUPPORT. [ ] Order that child support be paid by [ ] Petitioner [ ] Respondent in an amount as determined by the Court under the Arizona Child Support Guidelines. Support payments to begin on the first day of the month after the Judge or Commissioner signs the Order with all payments, plus the statutory handling fee, to be paid through the Support Payment Clearinghouse, PO Box 52107, Phoenix, Arizona 85072-7107 by income withholding order. [ ] Order that past child support be paid by [ ] Petitioner [ ] Respondent in an amount determined by using a retroactive application of the Arizona Child Support Guidelines taking into account any amount of temporary or voluntary / direct support that has been paid. Support to be paid as defined above. B. MEDICAL, DENTAL, VISION CARE FOR MINOR CHILDREN. Order that [ ] Petitioner is responsible for providing [ ] medical [ ] dental [ ] vision care insurance. [ ] Respondent is responsible for providing [ ] medical [ ] dental [ ] vision care insurance. [ ] Petitioner and Respondent will pay for all reasonable unreimbursed medical, dental, and health-related expenses incurred for the child(ren) in proportion to their respective incomes. C. Order payment of costs and attorney fees, if appropriate. D. Order such other relief as deemed necessary and appropriate by the Court. DO NOT SIGN UNTIL DIRECTED TO DO SO BY A NOTARY PUBLIC OR A CLERK OF THE SUPERIOR COURT. American LegalNet, Inc. www.FormsWorkFlow.com Case Number: Arizona Supreme Court Page 6 of 6 DRES11F-090617 OATH OR AFFIRMATION AND VERIFICATION I swear or affirm that the information in this document is true and correct under penalty of perjury. Date Signature STATE OF COUNTY OF Subscribed and sworn to or affirmed before me this: (date) by . (notary seal) Deputy Clerk or Notary Public American LegalNet, Inc. www.FormsWorkFlow.com