Person Filing: Mailing Address: City, State, Zip: Phone Number: Representing Self SUPERIOR COURT OF ARIZONA, COUNTY OF COCONINO Case Number (leave blank): DO Petitioner (me) I am the [ ] Mother [ ] Father PETITION FOR CHILD CUSTODY, PARENTING TIME, AND CHILD SUPPORT [ ] AND PATERNITY (Check this box if paternity has not been legally established) Respondent (the other parent) Respondent is the [ ] Mother [ ] Father Including Affidavit Regarding Minor Children I STATE THE FOLLOWING UNDER OATH: The Parents: The conciliation provisions have been met or do not apply. Respondent is not in military service. The children and I live in Arizona. Mother’s Name: Street Address: Phone Number: City, State, Zip: Birthdate: Father’s Name: Street Address: Phone Number: City, State, Zip: Birthdate: Paternity: [] Paternity has been legally established: [] A court order (copy attached) names Father as the children’s father. [] Mother and Father signed an Acknowledgment of Paternity (copy attached) through the Hospital Paternity Program or other means provided by law after July 18, 1996, and a birth certificate listing Father as the father was issued for each child as a result. Page 1 of 8 Revised August 2010 Coconino County Law Library and Self-Help Center Forms American LegalNet, Inc. www.FormsWorkFlow.com [] Paternity has not yet been legally established: The children were born to Mother when Mother and Father were not married to each other, Mother and Father had sexual intercourse on the children’s probable conception dates, and Father is the children’s natural father: [] And the results of a blood test (copy attached) indicate that the likelihood of Father’s paternity is 95% or greater. [] And Mother was married to a Husband other than Father at any time in the ten months before the children were born, or the children were born within ten months after Mother was divorced or legally separated from a Husband other than Father. Husband’s Name: [] And the children’s birth certificates list the name of a father other than Father. Name Listed: The Minor Children: A copy of each child’s birth certificate is attached. CHILD’S NAME: Birthdate: Where this child lived, dates lived there, and with whom the child lived, over the last 5 years: Address Dates With whom CHILD’S NAME: Birthdate: Where this child lived, dates lived there, and with whom the child lived, over the last 5 years: Address Dates With whom CHILD’S NAME: Birthdate: Where this child lived, dates lived there, and with whom the child lived, over the last 5 years: Address Dates With whom [ ] Yes [ ] No: I have participated, as a party or witness or in any other capacity, in another court case, described below, about the custody or parenting time of a child named above. CHILD’S NAME: Case Number: Court Name: Date of Child Custody Determination: Summary of Any Court Order: Page 2 of 8 Revised August 2010 Coconino County Law Library and Self-Help Center Forms American LegalNet, Inc. www.FormsWorkFlow.com CHILD’S NAME: Court Name: Summary of Any Court Order: Case Number: Date of Child Custody Determination: [ ] Yes [ ] No: Another court case, described below, involving a child named above, but not about custody or parenting time, could affect this case. CHILD’S NAME: Case Number: Court Name: The case is about: [ ] child support [ ] enforcement of court orders [ ] domestic violence [ ] a protective order [ ] adoption [ ] terminating parental rights [ ] a criminal matter [ ] other: CHILD’S NAME: Case Number: Court Name: The case is about: [ ] child support [ ] enforcement of court orders [ ] domestic violence [ ] a protective order [ ] adoption [ ] terminating parental rights [ ] a criminal matter [ ] other: [ ] Yes [ ] No: Someone other than me or the other parent has physical custody or claims rights of legal or physical custody or visitation with a child named above, as described below. CHILD’S NAME: Other Person’s Name: Other Person’s Address: Nature of the Claim: CHILD’S NAME: Other Person’s Name: Other Person’s Address: Nature of the Claim: Child Support Enforcement: [ ] Yes [ ] No: Arizona Child Support Enforcement has been involved in establishing spousal maintenance for me or the other parent or paternity or child support for any child named above, as described below. If yes, I will deliver a copy of this document to CSE on the day I file it. CHILD’S NAME: Name of court: Court case number: CHILD’S NAME: Name of court: Court case number: I ASK THE COURT TO ORDER THE FOLLOWING: Paternity: (Only complete the Paternity section if paternity has not been legally established.) [] [] [] Order that Father is the children’s father. Order that Father’s name be added to each child’s birth certificate. Order each child’s last name changed to Father’s last name and a new birth certificate issued for each child showing the new name. Page 3 of 8 Revised August 2010 Coconino County Law Library and Self-Help Center Forms American LegalNet, Inc. www.FormsWorkFlow.com [] [] [] Order that [ ] Mother or [ ] Father pay the other party $ for the cost of pregnancy, childbirth, and/or the children’s past medical expenses (billing statements attached). Order that Respondent pay me my costs and expenses for this action, including the cost of any genetic test the results of which are attached to this Petition. If Respondent denies paternity, order that Respondent, the children, and I submit to, and Respondent pay for, genetic testing necessary to establish paternity. Child Custody: [] Joint Custody: Award the parents joint custody of the children as stated in the Joint Custody Agreement we signed. No significant domestic violence has occurred between the parties. [] Sole Custody: Award [ ] me or [ ] my spouse sole legal custody and physical custody of the children. Joint custody is not in the children’s best interest because (you must fill in this blank if you ask for sole custody): Parenting Time: [] Order 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 we understand the court may enforce this drop-off and pick-up schedule, we 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. Page 4 of 8 Revised August 2010 Coconino County Law Library and Self-Help Center Forms American LegalNet, Inc. www.FormsWorkFlow.com [] We each are entitled to an annual -week vacation with the children. We will days in advance. work out the details of the vacation at least [] 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. We 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: Even Years Odd Years Mother Father Mother Father New Year’s Eve [] [] [] [] New Year’s Day [] [] [] [] Spring Vacation [] [] [] [] Easter [] [] [] [] Passover [] [] [] [] [] [] [] [] 4th of July Halloween [] [] [] [] Veteran’s Day [] [] [] [] Thanksgiving [] [] [] [] Hanukkah [] [] [] [] Christmas Eve [] [] [] [] 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. We may change the parenting plan by written agreement only, except in an emergency. Page 5 of 8 Revised August 2010 Coconino County Law Library and Self-Help Center Forms American LegalNet, Inc. www.FormsWorkFlow.com Reviewing the plan: We will review this Plan every necessary or desired changes. months and ask the court for any Other: [] Order 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. [] Order 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: Leave the Child Support section blank. The attorney at the Pre-Filing Meeting will help you with this. The Parent’s Worksheet for Child Support Amount dated the other parent is obligated to pay monthly child support of $ [] . Order that support. [] shows that [ ] I or [ ] Deviation: It would be inappropriate or unjust to apply that amount because: Therefore, free of duress and coercion, I ask the court to order that: [] [ ] I or [ ] the other parent pay monthly child support of $ [] Neither parent pay child support. Page 6 of 8 Revised August 2010 . Coconino County Law Library and Self-Help Center Forms American LegalNet, Inc. www.FormsWorkFlow.com This deviation is in the children’s best interest because: I understand that it is up to the court whether to grant this deviation and that the court can change child support at any time if a party asks for a change. Order that any child support obligation starts on: [] the date the Petition was filed. [] this date: . We started living apart on this date: [ ] Mother [ ] Father has voluntarily paid the other parent $ children since we started living apart. to support the Order that any payments be made through the Support Payment Clearinghouse by automatic wage assignment. If there are temporary child support orders, order a judgment for arrears when the judge signs the Decree. Medical, Dental, Vision Care for Minor Children: Order these expenses divided as follows: Mother is responsible for providing [ ] medical [ ] dental [ ] vision care insurance. Father is responsible for providing [ ] medical [ ] dental [ ] vision care insurance. Order the parties to pay for all reasonable un-reimbursed medical, dental, and health related expenses incurred for the children in proportion to the parties’ respective incomes as set forth in the most recent Parent’s Worksheet for Child Support Amount. Tax Exemptions: Leave the Tax Exemptions section blank. The attorney at the Pre-Filing Meeting will help you with this. Divide our income tax dependency exemptions as follows: Parent Entitled to Claim: Father Child’s Name Mother [] [] [] [] [] [] [] [] [] [] [] [] Tax Years I Request the Following Other Orders: I request any other orders that the court deems appropriate. Page 7 of 8 Revised August 2010 Coconino County Law Library and Self-Help Center Forms American LegalNet, Inc. www.FormsWorkFlow.com OATH AND VERIFICATION: I have read this Petition. It is true and complete to the best of my knowledge. My Signature: State of Arizona County of Subscribed and sworn before me this date: Seal: Page 8 of 8 Revised August 2010 ) ) ) by: Notary Public: Notary Expiration Date: Coconino County Law Library and Self-Help Center Forms American LegalNet, Inc. www.FormsWorkFlow.com