NOTE: Please print clearly the information requested below. Failure to do so may result in a delay in the processing of your request. Parties are advised that the filing of this petition is not in “response” to a petition for dissolution. Person Filing: Street Address: City, State, Zip: Phone Number: State Bar Number (if you are an attorney): IN THE SUPERIOR COURT OF ARIZONA, COUNTY OF COCONINO In re the Marriage of: Petitioner: Respondent: Case Number: DO PETITION FOR CONCILIATION COURT The [ ] Petitioner or [ ] Respondent in the above-entitled cause respectfully represents to the Judge of the Court of Conciliation as follows (please check those that apply): [] A controversy regarding visitation exists between the above-named parties, and the aid of this Court via mediation is requested to effect an amicable settlement of the controversy. [] A controversy regarding custody exists between the above-named parties, and the aid of this Court via a custody evaluation is requested to effect an amicable settlement of the controversy. [] The Petitioner/Respondent is requesting marriage counseling. 1. The Petitioner/Respondent fully understands that this Petition may not be withdrawn from Conciliation Court until the minimum required conferences have been concluded, or the Court for good cause terminates proceedings. 2. To the best of your knowledge, is a domestic relations action pending between the parties? [ ] Yes [ ] No 3. If there is not a domestic relations action pending, would your needs best be served by counseling only? [ ] Yes [ ] No Page 1 of 2 Revised August 2008 Coconino County Conciliation Court American LegalNet, Inc. www.FormsWorkflow.com 4. Has a Petition for Conciliation Court been filed previously in this Court by either spouse? [ ] Yes [ ] No. If Yes: The case number is: Filed in: In the county of: 5. My present address and telephone number is: Address: City: State: Telephone: Home: Work: Zip Code: 6. The other parent’s present address and telephone number is: Address: City: State: Telephone: Home: Work: Zip Code: 7. The name and age of each child under eighteen (18) years, including any step-children, whose welfare may be affected by the controversy is: Name Age Address Lives With WHEREFORE, your Petitioner prays this Court to make such orders in respect to the conduct of the spouses and the subject matter of the controversy as the Court deems necessary and proper to preserve the marriage or to effect a reconciliation of the spouses or an amicable settlement of the controversies involved. Date: Page 2 of 2 Revised August 2008 Petitioner’s Signature: Coconino County Conciliation Court American LegalNet, Inc. www.FormsWorkflow.com