FOR CLERK’S USE ONLY SUPERIOR COURT OF ARIZONA IN MARICOPA COUNTY ________________________________________ Name of Petitioner ________________________________________ Name of Respondent Case Number: JUDGMENT AND ORDER FOR PATERNITY and/or CHILD SUPPORT CUSTODY PARENTING TIME VITAL RECORDS (Check this box if any minor child was born in Arizona and the father’s name is to be added and/or the minor child’s last name is to be changed on the birth certificate.) 1. This case has come before the Court for a final Order. If necessary, the Court has taken any testimony needed to enter a final Order. 2. This Court has jurisdiction over the parties under the law. 3. Where it has the legal power to do so and where it is applicable to the facts of this case, this Court has considered, approved, and made an Order relating to paternity, child custody, support, parenting time, and expenses related to birth of the minor child(ren). 4. Petitioner and Respondent are the natural parents of the minor child(ren) named on birth certificates as: First Middle Last (a) (b) (c) who were born on this date and at this place: (List in same order as above) Month/ Day /Year City, State, Nation of Birth (a) (b) (c) ©Superior Court of Arizona in Maricopa County November 7, 2007 ALL RIGHTS RESERVED DRP81f Use only most current version Page 1 of 5 American LegalNet, Inc. www.FormsWorkflow.com Case No. 5. PARENT INFORMATION PROGRAM: A. Petitioner has attended the Parent Information Program class as evidenced by the Certificate of Completion in the court file. OR, has not attended the Parent Information Program class and shall be denied Petitioner any requested relief to enforce or modify this decree until Petitioner has completed the class. B. 6. Respondent has attended the Parent Information Program class as evidenced by the Certificate of Completion in the court file. OR has not attended the Parent Information Program class and shall be Respondent denied any requested relief to enforce or modify this decree until Respondent has completed the class. DEVIATION FROM CHILD SUPPORT: The court, having considered the best interests of the child(ren), deviates from the guidelines for the following reasons: Application of the guidelines is inappropriate. Application of the guidelines is unjust. The parties have signed a written agreement with knowledge of the amount of support that would have been ordered by the guidelines but for the agreement. The court makes the following finding regarding the deviation: The child support order would have been $ The child support order after deviation is $ All parties have signed the agreement free of duress and coercion. 7. PHYSICAL CUSTODY ADJUSTMENT, COURT APPROVED DISCRETIONARY PARENTING TIME ADJUSTMENT AND/OR OTHER ADJUSTMENTS. (The court must make written findings if any of these adjustments are made.) The court finds that the person responsible for paying child support has the ability to pay child support: In the amount entered on Line 33 of the Worksheet for $ In an adjusted amount calculated using the self-support reserve on line 35 of the Worksheet for $ 8. CUSTODY OF THE MINOR CHILD(REN). (Check and complete only if custody contested or joint custody ordered.) The custody order or agreement is in the best interests of the minor child(ren) for the following reasons: (List the reasons.) 9. SUPERVISED OR NO PARENTING TIME. (Check and complete only if supervised or no parenting time is ordered.) Supervised parenting time between the minor child(ren) and Respondent, ©Superior Court of Arizona in Maricopa County November 7, 2007 ALL RIGHTS RESERVED Petitioner OR DRP81f Use only most current version Page 2 of 5 American LegalNet, Inc. www.FormsWorkflow.com Case No. NO parenting time by Petitioner OR Respondent, is in the best interests of the minor child(ren), for the following reasons: (Explain the reasons) 10. DOMESTIC VIOLENCE. If the court enters an order for joint custody of the minor child(ren) 1. 2. 11. check box “1” or box “2” and explain. Domestic violence has not occurred during this relationship, OR Domestic violence has occurred, but the domestic violence has not been significant. Explain why joint custody is in the best interest of the minor child(ren) even though domestic violence has occurred: DRUG CONVICTION WITHIN LAST TWELVE MONTHS. (Check, if applicable). If either party has been convicted of driving under the influence of alcohol or drugs, or was convicted of any drug offense within 12 months of filing the request for custody, the custody and/or parenting time arrangement ordered by this Court appropriately protects the minor child(ren). THE COURT ORDERS: 1. PATERNITY: (Name of father as on his birth certificate) First Middle Last is declared to be the natural father of the minor child(ren). 2. 3. 4. FOR ANY CHILDREN BORN IN THE STATE OF THE ARIZONA, THE CLERK OF COURT SHALL FORWARD A COPY OF THIS ORDER TO THE OFFICE OF VITAL RECORDS, WHICH IS ORDERED TO AMEND THE BIRTH CERTIFICATE(S) AS FOLLOWS: The father’s name shall be entered on the minor child(ren)'s birth certificate. The minor child/children’s last name shall be changed to: CHILD CUSTODY AND PARENTING TIME: 1. SOLE CUSTODY: Sole custody of the minor child(ren) is awarded to: Petitioner or Respondent, subject to parenting time as follows: (A) Parenting Time to the parent not having custody according to the Parenting Plan attached to and made a part of this Order. OR, (B) Supervised parenting time, but only in the presence of another person, who is named below or otherwise approved by the Court. Name of supervisor: Restrictions on parenting time: ©Superior Court of Arizona in Maricopa County November 7, 2007 ALL RIGHTS RESERVED DRP81f Use only most current version Page 3 of 5 American LegalNet, Inc. www.FormsWorkflow.com Case No. The cost of supervised parenting time shall be paid by: Petitioner or Respondent or shared equally by the parties. OR No parenting time rights to Petitioner or Respondent. (see next page) OR 2. JOINT CUSTODY: Petitioner and Respondent agree to act as joint custodians of the minor child(ren), as set forth in the Parenting Plan signed by both parties and attached to and made a part of this Order. There have been no significant acts of Domestic Violence by either parent. The Court adopts the agreed terms of the Parenting Plan that describes the custody and parenting time and/or support agreement between the parties. By attaching the Parenting Plan to the Order, the Parenting Plan becomes part of the final Order and carries the same legal weight as any other Order. 5. CHILD SUPPORT: PETITIONER or RESPONDENT shall pay child support to the other party in the amount per month, beginning THE FIRST DAY OF THE MONTH following the of $ signing of this Decree, according to the Child Support Worksheet. All child support payments shall be made through the Support Payment Clearinghouse, plus an applicable statutory fee. Payments shall be in equal installments made on the 1st and 15th of each month thereafter through an automatic wage assignment. Costs for past child support and care for minor child(ren) in the amount of $ be paid by PETITIONER or RESPONDENT in the amount of $ month until paid in full. Payments shall be made as stated above. 6. shall each MEDICAL/DENTAL/VISION CARE INSURANCE EXPENSES FOR CHILDREN PETITIONER is ordered to provide medical, dental vision care insurance. RESPONDENT is ordered to provide medical, dental vision care insurance. The party ordered to pay for medical/dental/vision care insurance must keep the other party informed of the insurance company’s name, address, and telephone number, and provide the other party with the documents necessary to submit insurance claims. PETITIONER is ordered to pay % and/or RESPONDENT is ordered to pay % of all reasonable uncovered and/or uninsured medical, dental, vision care, prescription, and other health care expenses for the minor child(ren), including co-payments. Costs for past medical expenses for minor child(ren) in the amount of $ paid by PETITIONER or RESPONDENT in the amount of $ until paid in full. Payments shall be made as stated above. shall be each month 7. PETITIONER or RESPONDENT is awarded judgment in the amount of $ for expenses incurred relating to medical care, hospitalization and other costs related to the birth of the minor child(ren), which shall be paid by PETITIONER or RESPONDENT. 8. FINANCIAL INFORMATION EXCHANGES: The parties shall exchange financial information (tax returns, spousal affidavits, earning statements and/or other related financial statements) every twenty-four months. OTHER COSTS: ©Superior Court of Arizona in Maricopa County November 7, 2007 ALL RIGHTS RESERVED DRP81f Use only most current version Page 4 of 5 American LegalNet, Inc. www.FormsWorkflow.com Case No. 9. LIMITATION ON JURISDICTION: (check box if applicable) This Court cannot make a legal order, without personal service on (the other party) with respect to issues of child support, medical and dental insurance for the minor child(ren) or regarding costs relating to the birth of the child(ren). The court reserves jurisdiction to enter further orders at such time as the Court acquires personal jurisdiction over the Respondent. 10. OTHER ORDERS: This Court makes further Orders relating to this matter as follows: DONE IN OPEN COURT JUDICIAL OFFICER ACKNOWLEDGEMENT OF THE PARTIES OR THEIR ATTORNEYS APPROVED BY: Petitioner’s Signature Signed and sworn to or affirmed before me this date: by: Notary Public Michael K. Jeanes, Clerk of Superior Court OR My commission expires: By: Deputy Clerk If you are filing a Consent Decree or if there has been a trial, the Respondent must sign: Respondent’s Signature Signed and sworn to or affirmed before me this date: Notary by: Public Michael K. Jeanes, Clerk of Superior Court OR My commission expires: By: Deputy Clerk If either party is represented by a lawyer, the lawyer must sign: Petitioner’s Lawyer: Date: Respondent’s Lawyer: Date: ©Superior Court of Arizona in Maricopa County November 7, 2007 ALL RIGHTS RESERVED DRP81f Use only most current version Page 5 of 5 American LegalNet, Inc. www.FormsWorkflow.com