(1) Person Filing: Street Address: City, State, Zip: Phone Number: Representing Self SUPERIOR COURT OF ARIZONA, COUNTY OF COCONINO (2) Petitioner: (4) Case Number: DO (3) Respondent: REQUEST FOR HEARING AND NOTICE OF HEARING (Simplified Procedure) A Request to Modify (change) Child support pursuant to the guidelines’ simplified procedure has been filed. The information provided on the Parent’s Worksheet that was the basis for the request to modify (change) child support is not accurate. I am attaching the required completed Parent’s Worksheet that shows what I believe to be accurate information. I request that a hearing be set so I can explain my position to the judge or commissioner. I further request that costs and fees incurred in responding to this matter be ordered to be paid by the other party. Upon receipt of the hearing date, I will immediately mail a copy of this Request for Hearing and Notice of Hearing to the other party or such person’s attorney as follows: (5) Name: Street Address: City, State, Zip: If one of the parties is using the child support services of the Department of Economic Security, I will also immediately mail a copy of this Request for Hearing and Notice of Hearing to: Department of Economic Security Child Support Enforcement Attn: Modification, Coconino County 2323 N. Walgreen St. Flagstaff, AZ 86004 Page 1 of 2 Revised June 2006 Coconino County Law Library and Self-Help Center Forms American LegalNet, Inc. www.FormsWorkflow.com I have read this Request, and it is true and complete to the best of my knowledge. (6) Signature: State of Arizona ) ) ) County of Subscribed and sworn before me this date: Seal: by: Notary Public: Notary Expiration Date: NOTICE OF HEARING The above verified Request for Hearing having been filed, this matter shall be heard: DATE AND TIME: PLACE: If either party fails to appear at the hearing after proper notice, the Court will take evidence from the party who does appear and make a decision based on the information provided in the Request to Modify (Change) Child Support, Request for Hearing, and any oral testimony. Date: Judicial Officer: NOTICE TO PARTIES An arrearage calculation may be completed on your case. If it is determined that there is an overpayment or an arrearage owing, the monthly obligation could be adjusted to bring your case current. Page 2 of 2 Revised June 2006 Coconino County Law Library and Self-Help Center Forms American LegalNet, Inc. www.FormsWorkflow.com