Person Filing: Mailing Address: City, State, Zip: Phone Number: Representing Self SUPERIOR COURT OF ARIZONA, COUNTY OF COCONINO Petitioner: [ ] Mother [ ] Father Case Number: DO DECREE OF CHILD CUSTODY, PARENTING TIME, AND CHILD SUPPORT [ ] AND PATERNITY ORDER Respondent: [ ] Mother [ ] Father Atlas Number: THE COURT FINDS: This case has come before the court for a Decree of Child Custody, Parenting Time, and Child Support. The court has taken all testimony needed to enter a Decree. The court has jurisdiction over the parties under the law, and the provisions of this Decree are fair and reasonable under the circumstances. The conciliation provisions have been met or do not apply. Minor Children: The following children were born to Petitioner and Respondent when they were not married to each other. CHILD’S NAME: Birthdate: CHILD’S NAME: Birthdate: CHILD’S NAME: Birthdate: Parent Information Class: Leave the Parent Information Class section blank. [] The parties have attended the Parent Information Class as evidenced by the Certificates of Completion in the court file, or attendance has been waived by the Court; OR Page 1 of 6 Revised February 2011 Coconino County Law Library and Self-Help Center Forms American LegalNet, Inc. www.FormsWorkFlow.com [] [ ] Petitioner and/or [ ] Respondent has not completed the parent information class. Until completion of the class, the court may deny relief in favor of that party, hold that party in contempt of court, or impose any other sanction reasonable in the circumstances, including but not limited to enforcing or modifying this Decree. THE COURT ORDERS: Paternity: [] [] Father is the children’s father. Father’s Name: Father’s name shall be added to each child’s birth certificate. If any of the children’s birth certificates list the name of a father other than Father, that name shall be changed as follows: Child’s Name Change This Father’s Name: To This Father’s Name: [] Each child’s last name is changed to Father’s last name, and for each child a new birth certificate shall be issued showing the new name, as follows: The Current Name Is Changed to the New Name Birthdate [] [ ] Petitioner or [ ] Respondent shall pay the other party $ for the cost of pregnancy, childbirth, and/or the children’s past medical expenses in the amount of $ per month until paid in full. The first payment is due on the first day of . Respondent shall pay Petitioner $ for Petitioner’s costs and expenses for this action in the amount of $ per month until paid in full. The first payment is due on the first day of . [] Child Custody: [] Joint Custody: The parties are awarded joint custody of the children as set forth in the Joint Custody Agreement signed by the parties and filed with the Court. The Court adopts the terms of the Agreement. The Agreement has become part of the Decree and carries the same legal weight as the Decree. [] Sole Custody: [ ] Petitioner or [ ] Respondent is awarded sole legal custody and physical custody of the children. Page 2 of 6 Revised February 2011 Coconino County Law Library and Self-Help Center Forms American LegalNet, Inc. www.FormsWorkFlow.com Parenting Time: [] The Court Orders This Parenting Time Plan: The children will be in Father’s care at these times: At the start of Father’s time with the children, [ ] Mother will drop them off or [ ] Father will pick them up at this time: at this location: . The children will be in Mother’s care at these times: At the start of Mother’s time with the children, [ ] Father will drop them off or [ ] Mother will pick them up at this time: at this location: . While the parents understand the court may enforce this drop-off and pick-up schedule, they will be reasonably flexible about it. Other scheduling arrangements: [] During summer months or school breaks longer than four days not listed in the holiday schedule below, the children will be in [ ] Mother’s or [ ] Father’s care. [] Each parent is entitled to an annual -week vacation with the children. The parents will work out the details of the vacation at least days in advance. [] Neither parent will travel with the children outside Arizona for longer than days without the prior written consent of the other parent or order of the court. The parents will inform each other of plans to travel out of the area with the children and of addresses and phone numbers where we and children can be reached during travel. Holidays: New Year’s Eve New Year’s Day Spring Vacation Easter Passover 4th of July Halloween Veteran’s Day Thanksgiving Hanukkah Christmas Eve Page 3 of 6 Revised February 2011 Even Years Mother Father [] [] [] [] [] [] [] [] [] [] [] [] [] [] [] [] [] [] [] [] [] [] Odd Years Mother Father [] [] [] [] [] [] [] [] [] [] [] [] [] [] [] [] [] [] [] [] [] [] Coconino County Law Library and Self-Help Center Forms American LegalNet, Inc. www.FormsWorkFlow.com Even Years Odd Years Holidays: Christmas Day [] [] [] [] Winter Break [] [] [] [] Children’s Birthdays [] [] [] [] [] Mother will have the children on Mother’s Day and Father will have the children on Father’s Day. [] Each parent will have the children on that parent’s birthday. [] On three-day weekends, which include Martin Luther King Day, President’s Day, Memorial Day, Labor Day, and Columbus Day, the children will remain in the care of the parent who has them for the weekend. Holiday times will begin and end as follows: Phone access: [] Each parent may contact the children by phone during the children’s normal waking hours. [] Other: Religion: [] Each parent may take the children to a place of worship of that parent’s choice while the children are in that parent’s care. [] The children may be instructed in the following faith: [] Religious arrangements do not apply to this Plan. The parents may change the parenting plan by written agreement only, except in an emergency. Reviewing the plan: The parents will review this Plan every court for any necessary or desired changes. months and ask the Other: [] The Court Orders Supervised Parenting Time: Unsupervised parenting time would seriously endanger the children’s physical, mental, moral, or emotional health because: Parenting time may take place only in the presence of another person, named as follows: Other restrictions on parenting time: The cost of supervised parenting time, if any, will be paid [ ] by the parent being supervised or [ ] by the custodial parent or [ ] equally by both parties. Page 4 of 6 Revised February 2011 Coconino County Law Library and Self-Help Center Forms American LegalNet, Inc. www.FormsWorkFlow.com [] The Court Orders No Parenting Time: Even supervised parenting time with the other parent would seriously endanger the children’s physical, mental, moral, or emotional health because: Child Support: Child support shall be paid as stated in the Child Support Order issued on or about this date: (leave blank) . The child support obligation shall continue until the children have reached age 18 and graduated from high school or have reached 19 and have not graduated from high school. The paying parent must apply to the court to terminate child support payments. Children’s Insurance and Health Care Expenses: These expenses shall be paid as allocated in the Child Support Order. The party ordered to pay shall keep the other party informed of the insurance company name, address, and phone number and provide the other party with all documents necessary to submit insurance claims. Tax Exemptions: The parties’ income tax dependency exemptions are divided as stated in the Child Support Order. A party required to pay child support shall claim children as income tax dependency deductions only if the parent has paid all child support due and owing. If there is unpaid child support owed at the end of the tax year, the non-paying party is entitled to claim all deductions for the tax year. Enforcement of Temporary Orders: (Leave this paragraph blank.) For obligations ordered to be paid in the temporary orders dated : [ ] they are satisfied in full or [ ] judgment is awarded against the party with the obligation. The amount owing as of the date of this Decree is $ . At the legal rate of interest, the total amount currently owing is $ . Other Orders: Petitioner shall mail a copy of this decree to Respondent. Date: Page 5 of 6 Revised February 2011 Superior Court Judge: Coconino County Law Library and Self-Help Center Forms American LegalNet, Inc. www.FormsWorkFlow.com APPROVED BY: I have read this Decree, the Child Support Order, and the Order of Assignment and agree to be bound by their terms and conditions. Sign in front of a notary. Notaries are at the Self-Help Center in the Courthouse and at most banks or listed in the Yellow Pages. The person signing must bring photo ID. Notaries usually charge a fee. Petitioner’s Signature: State of Arizona County of Subscribed and sworn before me this date: Seal: Page 6 of 6 Revised February 2011 ) ) ) by: Notary Public: Notary Expiration Date: Coconino County Law Library and Self-Help Center Forms American LegalNet, Inc. www.FormsWorkFlow.com