Person Filing: Mailing Address: City, State, Zip: Phone Number: Representing Self SUPERIOR COURT OF ARIZONA, COUNTY OF COCONINO Petitioner’s Name on the Current Custody Order: Respondent’s Name: Case Number: DO PETITION FOR MODIFICATION OF CHILD CUSTODY, PARENTING TIME, AND CHILD SUPPORT I STATE THE FOLLOWING UNDER OATH: I am the [ ] Petitioner or [ ] Respondent. I’m asking the court to change the current custody order. The Current Order: This court signed the current custody order on this date: . It orders: [ ] joint custody [ ] sole custody to Mother [ ] sole custody to Father It orders that the children live primarily with: [ ] Mother [ ] Father The part about parenting time that I want to change currently says: The court signed the current Child Support Order on this date: It orders monthly child support payments of: $ Page 1 of 6 Revised August 2010 Coconino County Law Library and Self-Help Center Forms American LegalNet, Inc. www.FormsWorkFlow.com If The Court Signed the Current Custody Order Less Than One Year Ago: [] The children are in danger because: [] There is an Order of Protection against the other parent dated [] We have joint custody, the court signed the current custody order less than six months ago, and the other party is disobeying the order as follows: Mediation: [] The current custody order says we have to go to mediation before asking the court to change the order. [] We went to mediation on this date: about the change in custody and/or parenting time. [] We did not go to mediation because: , but we still disagree I ASK THE COURT TO CHANGE THE CURRENT ORDER AS FOLLOWS: Change Custody To: [] Joint Custody: Award the parents joint custody of the children as stated in the Joint Custody Agreement dated and filed with this Petition. No significant domestic violence has occurred between the parties. [] Sole Custody: Award [ ] Mother or [ ] Father 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): Page 2 of 6 Revised August 2010 Coconino County Law Library and Self-Help Center Forms American LegalNet, Inc. www.FormsWorkFlow.com Change Parenting Time To: [] 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. [] We each are entitled to an annual -week vacation with the children. We 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. 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: New Year’s Eve New Year’s Day Spring Vacation Easter Passover 4th of July Halloween Veteran’s Day Thanksgiving Hanukkah Page 3 of 6 Revised August 2010 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 Mother Father Mother Father 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. 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: Page 4 of 6 Revised August 2010 Coconino County Law Library and Self-Help Center Forms American LegalNet, Inc. www.FormsWorkFlow.com 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: Change Child Support To: The Parent’s Worksheet for Child Support Amount dated and filed with this Petition shows that [ ] I or [ ] the other parent is obligated to pay monthly child support of $ [] Order that support. [] 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. 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. 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: Divide our income tax dependency exemptions as follows: Parent Entitled to Claim: Mother Father [] [] [] [] Page 5 of 6 Revised August 2010 Child’s Name Tax Years (even or odd, for example) [] [] [] [] Coconino County Law Library and Self-Help Center Forms American LegalNet, Inc. www.FormsWorkFlow.com Mother Father [] [] Child’s Name Tax Years (even or odd, for example) [] [] Order These Other Changes: Why I’m Asking for These Changes: All of these changes are in the children’s best interest. I’m asking for these changes because the following circumstances have changed since the court signed the last custody order: OATH AND VERIFICATION: I have read this document, and it is true and complete to the best of my knowledge. 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. My Signature: State of Arizona County of Subscribed and sworn before me this date: Seal: Page 6 of 6 Revised August 2010 ) ) ) by: Notary Public: Notary Expiration Date: Coconino County Law Library and Self-Help Center Forms American LegalNet, Inc. www.FormsWorkFlow.com