Petitioner's Name: Mailing Address: City, State, Zip: Phone Number: Representing Self SUPERIOR COURT OF ARIZONA, COUNTY OF COCONINO In re the marriage of: Petitioner (My name) Case Number (leave blank): DO PETITION FOR LEGAL SEPARATION WITH CHILDREN Including Affidavit Regarding Minor Children Respondent (My spouse's name) I STATE THE FOLLOWING UNDER OATH: The Parties and the Marriage: My Name: Street Address: City, State, Zip: Birthdate: Phone Number: Job title: Number of months/years in a row to date I have lived in Arizona: If not living in Arizona now, I [ ] lived [ ] did not live in Arizona at some point during our marriage. My Spouse's Name: Street Address: City, State, Zip: Birthdate: Phone Number: Job title: Number of months/years in a row to date my spouse has lived in Arizona: If not living in Arizona now, my spouse [ ] lived [ ] did not live in Arizona at some point during our marriage. The Marriage: Date of Marriage: City and state or country where we were married: Our marriage is irretrievably broken or I and/or my spouse desire to live separate and apart. The conciliation provisions have been met or do not apply. We do not have a covenant marriage. Military Service: My spouse is not in military service. Residency: I live in Arizona. Page 1 of 10 Revised March 2012 Coconino County Law Library and Self-Help Center Forms American LegalNet, Inc. www.FormsWorkFlow.com Minor Children of the Marriage: Pregnancy: [ ] Yes [ ] No: Wife is pregnant. Baby is due on [ ] Yes [ ] No: Husband is believed to be the father. [] (Leave this checkbox blank) The FLAP Attorney advised me that having children born or conceived during the marriage to a father other than Husband may complicate my case and that I could ask for a paternity order or see an attorney on my own for advice and options. Minor Children: The following children, who are under 18 and are my spouse's and my biological or adopted children, will have lived in Arizona for at least the six months before I file this Petition or have lived in Arizona since birth. 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 18-Year-Old High School Student: The following child, who is 18 and in high school and is my spouse's and my biological or adopted child, will have lived in Arizona for at least the six months before I file this Petition or has lived in Arizona since birth. Birthdate: CHILD'S NAME: Where this child lived, dates lived there, and with whom the child lived, over the last 5 years: Address Dates With whom Page 2 of 10 Revised March 2012 Coconino County Law Library and Self-Help Center Forms American LegalNet, Inc. www.FormsWorkFlow.com 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: CHILD'S NAME: Case Number: Court Name: Date of Child Custody Determination: Summary of Any Court Order: [ ] 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: Page 3 of 10 Revised March 2012 Coconino County Law Library and Self-Help Center Forms American LegalNet, Inc. www.FormsWorkFlow.com I ASK THE COURT TO ORDER THE FOLLOWING: Legal Separation: Order that my spouse and I are legally separated. 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 at this location: pick them up at this time: 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. [] 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 th