Superior Court of Arizona Maricopa County Juvenile Cover Sheet FOR CLERK’S USE ONLY Check one: Dependency Case Number (Clerk will stamp case # when Termination of Parental Rights documents are filed). Adoption ATLAS number(s): Instructions: (if applicable) • Provide the following information requested about each party. • Type or print neatly in black ink. • If more room is needed, please attach a separate page. Information about the Petitioner: Name:_______________________________________ Business phone: ( )_______________________ Address:_____________________________________ Cell phone/pager:( )______________________ City, State, Zip:_______________________________ Title (if applicable):____________________________ Home phone: ( ) ___________________________ E-mail address: ______________________________ Attorney name/Bar number: ____________________ Relationship to child(ren): ______________________ Information about the Children: Names, Dates of Birth, and Social Security Numbers for Minor Children Involved: Name: Name: Name: Name: DOB: DOB: DOB: DOB: SSN: SSN: SSN: SSN: Information about Mother of Child(ren): Information about Father of Child(ren)*: Name: _____________________________________ Name: _____________________________________ Address: ___________________________________ Address: ___________________________________ City, State, Zip: _____________________________ City, State, Zip: _____________________________ Home phone #: ( Home phone #: ( )________________________ Work phone number: ( Cell phone/pager: ( )____________________ ) ______________________ )________________________ Work phone number: ( Cell phone/pager: ( )____________________ ) ______________________ Date of Birth: _______________________________ Date of Birth: _______________________________ Social Security #: ___________________________ Social Security #: ___________________________ E-mail address: _____________________________ E-mail address: _____________________________ Names of children: __________________________ ___________________________________________ © Superior Court of Arizona in Maricopa County July 17, 2007 ALL RIGHTS RESERVED JV10f Page 1 of 3 Use current version American LegalNet, Inc. www.FormsWorkflow.com Case No. (* If there is more than one father, please list additional fathers on page three (3). Also please specify, if there are multiple fathers, which fathers are connected with which children.) Please list ANY siblings of the children listed above who are NOT involved in this case: Name: DOB: ____________ SSN: ___________ Name: __________________________ DOB: ____________ SSN: ___________ Name: __________________________ DOB: ____________ SSN: ___________ Names, Date of Birth and Social Security Numbers for ANY adult, over the age of 18, who is living in the same home as any of the children listed above: Name: DOB: ____________ SSN: ___________ Name: __________________________ DOB: ____________ SSN: ___________ Name: __________________________ DOB: ____________ SSN: ___________ Have there been any other cases (EXCLUDING minor traffic offenses) in any court involving members of this family? [ ] Yes [ ] No. If yes, please describe, and provide case numbers if known: ____________________________________________________________________________ ________________________________________________________________ Domestic Violence Section Has anyone mentioned on this cover sheet been the victim of any family or domestic violence? Yes No. If yes, please identify: ____________________________________________ Has anyone mentioned on this cover sheet been the plaintiff, defendant, or named on 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 on this cover sheet in any physical danger due to abuse or neglect? Yes No. Has anyone named on this sheet had any involvement with AZ Child Protective Services? Yes No. If yes, please provide CPS or Juvenile Court case #: __________________________________ Name, phone, and site code of case manager: _____________________________________________ Are any of the children listed on this cover sheet eligible for Tribal enrollment? Yes No. If yes, please indicate which Tribe/Nation: ___________________________________ Are any of the parents listed on this cover sheet Native Americans? Yes No. Tribal information/ contact: ______________________________________________ © Superior Court of Arizona in Maricopa County July 17, 2007 ALL RIGHTS RESERVED JV10f Page 2 of 3 Use current version American LegalNet, Inc. www.FormsWorkflow.com Case No. LOCATION: (Check the Superior Court location where you are filing these documents) Mesa – Juvenile Court (1810 S. Lewis St.) Durango – Juvenile Court (3131 W. Durango St.) INTERPRETER: Is an interpreter needed for any of the parties? If so, please check the appropriate box below. NOTE: THIS IS NOT A REQUEST FOR AN INTERPRETER, THIS INFORMATION IS FOR INTERNAL PURPOSES ONLY. Petitioner Mother Father An interpreter is needed for: (if more than one father, indicate which father needs an interpreter): __________________________. Language: Spanish Other: Please specify: _______________________. Information about Additional Father of Child(ren) (If applicable) Name: _________________________ __ Address: __________________________ City, State, Zip: _____________________ Home phone #: ( )_______________ __ Work phone number: ( )_____________ Cell phone/pager: ( ) _______________ Date of Birth: ____________________ _ _ Social Security #: _______________ ___ E-mail address: _____________________ Name(s) ofchild(ren):_________________ __________________________________ Information about Additional Father of Child(ren) (If applicable) Name: ____________________________ Address: __________________________ City, State, Zip: _____________________ Home phone #: ( )_________________ Work phone number: ( )_____________ Cell phone/pager: ( ) _______________ Date of Birth: _______________________ Social Security #: ______________ ___ E-mail address: _____________________ Name(s) of child(ren): ______________ _ __________________________________ © Superior Court of Arizona in Maricopa County July 17, 2007 ALL RIGHTS RESERVED JV10f Page 3 of 3 Use current version American LegalNet, Inc. www.FormsWorkflow.com