For Clerk’s Use Only Superior Court of Arizona Maricopa County Family Court Cover Sheet FOR USE WITH MINOR CHILDREN Check only one box that matches the legal procedure for which you are filing the documents in this packet: Modification (Change) of Custody Modification (Change) of Parenting Time (Visitation) Modification (Change) of Support Only Modification (Change or Stop) of Assignment Only Enforcement of Custody, Parenting Time (Visitation) or Support Enforcement of Property Division Other Case Number from existing FC case ATLAS number(s) if applicable Instructions: • You must provide the following information about yourself and the other party. • Type or print neatly in black ink • If more room is needed for children or Petitioner/Respondent, please attach a separate page • You must list the Petitioner from the original case as the Petitioner below and the Respondent from the original case as the Respondent below Information About the Petitioner: Information About the Respondent: Name: Name: Address: Address: City, State, Zip: City, State, Zip: Home phone #: Home phone #: Work phone #: Work phone #: Cell phone/pager: Cell phone/pager: Date of Birth: Date of Birth: Social Security #: Social Security: E-mail address: E-mail address: ©Superior Court of Arizona in Maricopa County September 27, 2005 ALL RIGHTS RESERVED DRM10f USE CURRENT VERSION Page 1 of 2 American LegalNet, Inc. www.FormsWorkflow.com Case No. Lawyer’s Name and Bar Number: __________________________________________________ (Provide this information only if YOU have an attorney) Names, Dates of Birth, and Social Security Numbers for Minor Children Involved: Name: DOB: SSN: Name: DOB: SSN: Name: DOB: SSN: Name: DOB: SSN: Names and D/O/B’s of any OTHER minor children of the Petitioner and/or the Respondent who are NOT involved in this case. Have there been any other cases (EXCLUDING minor traffic offenses) in any court involving members of this family? Yes No. If you checked the “Yes” box, please describe the case and include case numbers and court location. Domestic Violence Section Is anyone mentioned on this cover sheet currently a victim of any family or domestic violence? Yes No Has anyone listed on this cover sheet been the plaintiff, defendant, or named in a petition for an Order of Protection? Yes No If Yes, please identify: ________________________________________________________ Was the Order of Protection granted by the Maricopa County Superior Court? Yes No If No, in what court was the Order of Protection granted? _____________________________ Children’s Issues Section Are any of the children named above in any physical danger due to abuse or neglect? Yes No Has anyone named on this sheet had any involvement with Child Protective Services in Arizona? Yes No If Yes, please provide the CPS or Juvenile Court case number: INTERPRETER. Is an interpreter needed for either of the parties? If so, please check the appropriate box(es) below. NOTE: THIS IS NOT AN OFFICIAL REQUEST FOR AN INTERPRETER. THIS INFORMATION IS TO BE USED FOR INTERNAL PURPOSES ONLY. Petitioner Language: Respondent Spanish/(Español) Other LOCATION. (Check the Superior Court Location where you will be filing these documents: Downtown Phoenix Southeast Regional (Mesa) Northeast Regional (Phoenix) ©Superior Court of Arizona in Maricopa County September 27, 2005 ALL RIGHTS RESERVED Northwest Regional (Surprise) DRM10f USE CURRENT VERSION Page 2 of 2 American LegalNet, Inc. www.FormsWorkflow.com