Person Filing: Address (if not protected): City, State, Zip Code: Telephone: Email Address: Lawyer's Bar Number: Representing Self, without a Lawyer or Attorney for Petitioner OR For Clerk's Use Only Respondent SUPERIOR COURT OF ARIZONA IN MARICOPA COUNTY In the Matter of: Case Number (Clerk will stamp case # when submitted) DEPENDENCY COVERSHEET (Not Public Record) (person(s) under 18 years of age) This Coversheet is for internal Court use only and is not part of the legal file. Information about the Children Involved: Name: DOB: ___ Black or African American ___ Anglo ___ Asian ___ Native Hawaiian/Pacific Islander Ethnicity: (choose one) ___ Native American ___ Hispanic/Latin ___ Other Origin ___ Unknown Name: DOB: ___ Black or African American ___ Anglo ___ Asian ___ Native Hawaiian/Pacific Islander Ethnicity: (choose one) ___ Native American ___ Hispanic/Latin ___ Other Origin ___ Unknown Name: DOB: ___ Black or African American ___ Anglo ___ Asian ___ Native Hawaiian/Pacific Islander Ethnicity: (choose one) ___ Native American ___ Hispanic/Latin ___ Other Origin ___ Unknown Name: DOB: ___ Black or African American ___ Anglo ___ Asian ___ Native Hawaiian/Pacific Islander Ethnicity: (choose one) ___ Native American ___ Hispanic/Latin ___ Other Origin ___ Unknown � Superior Court of Arizona in Maricopa County - Juvenile Division ALL RIGHTS RESERVED Page 1 of 2 JVD10f 081414 Use current form American LegalNet, Inc. www.FormsWorkFlow.com Case No. Please list ANY siblings of the children listed above who are NOT involved in this case: Name: DOB: Name: DOB: Name: DOB: Other Court Cases: Have there been any other cases (EXCLUDING minor traffic offenses) in any court involving members of this Yes No family? If yes, please describe, and provide case numbers if known: Interpreter/Language Needs: NOTE: THIS INFORMATION IS NECESSARY SO AN INTERPRETER CAN BE REQUESTED. IT IS FOR INTERNAL PURPOSES ONLY. Is an interpreter needed for any of the parties? Yes No If yes, please check the appropriate box below. An interpreter is needed for: Petitioner or Guardian Mother Father (if more than one father, indicate which father needs an interpreter): If yes, Language: Spanish Other: (please specify) This Coversheet is for internal Court use only and is not part of the legal file. � Superior Court of Arizona in Maricopa County - Juvenile Division ALL RIGHTS RESERVED Page 2 of 2 JVD10f 081414 Use current form American LegalNet, Inc. www.FormsWorkFlow.com