Person Filing: Address (if not protected): City, State, Zip Code: Telephone: Email Address: ATLAS Number: Lawyer222s Bar Number: Representing Self, without a Lawyer or Attorney for Petitioner OR Respondent SUPERIOR COURT OF ARIZONA IN MARICOPA COUNTY Case Number: Name of Petitioner/Party A (in original case) ORDER MODIFYING LEGAL DECISION- MAKING (LEGAL CUSTODY), PARENTING TIME AND CHILD SUPPORT Name of Respondent/Party B (in original case) THE COURT FINDS: 1. This case has come before this Court for a final Order based upon the agreement of the parties. 2. This Court has jurisdiction to change legal decision-making (legal custody), parenting time, and support, and has jurisdiction over the parties. 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 Orders relating to legal decision-making, parenting time and support. 3. This Order applies to the following children: NAMES BIRTH DATE / AGE 4. GROUNDS FOR CHANGING LEGAL DECISION-MAKING AND PARENTING TIME. Based upon the stipulation (agreement) of the parties, it is in the best interest of the child(ren) to change legal custody and parenting time at this time. 5. JOINT LEGAL DECISION-MAKING CASES ONLY. Domestic Violence. (If requesting joint legal decision-making, this statement must be true (ARS 247 25-403.03). Check box if a true statement.) There has been no domestic violence, or no significant domestic violence. For clerk use only 251 Superior Court of Arizona in Maricopa County DRMC78f- 010119 ALL RIGHTS RESERVED Page 1 of 4 American LegalNet, Inc. www.FormsWorkFlow.com Case No. THE COURT ORDERS: 1. The Order regarding legal decision-making, parenting time and support dated is changed as follows: A. LEGAL DECISION-MAKING (LEGAL CUSTODY) AND PARENTING TIME. Joint Legal Decision-making. Party A and Party B agree to act as joint legal decision-makers of the minor child(ren) with parenting time and physical custody as set forth in the Joint Legal Decision-making Agreement and Parenting Plan pursuant to A.R.S. Section 247 25-403, signed by both parties and attached to and made a part of this Order. There have been no significant acts of Domestic Violence under A.R.S. 247 13-3601 by either parent. The Court adopts the agreed terms of the Joint Legal Decision-making Agreement. OR Sole Legal Decision-making. Party A is awarded sole legal decision-making and physical custody of ; Party B is awarded sole legal decision-making and physical custody of, as described in the parenting time schedule in the attached Parenting Plan signed by both parties. B. CHILD SUPPORT. Party A or Party B shall pay child support to the other party in the amount of $ per month payable on the first day of each month, beginning the first day of the month following the signing of this Order. Child support is based on Exhibit 1 attached hereto and incorporated by reference. All child support payments shall be made through the Clerk of Superior Court/ Clearinghouse, plus an applicable statutory fee by Order of Assignment. CHILD SUPPORT DEVIATION. The Court, having considered the best interests of the child(ren), deviates from the guidelines for the following reasons. (Describe reasons.) C. MEDICAL AND DENTAL INSURANCE, PAYMENTS AND EXPENSES. Party A is responsible for providing: medical dental vision care insurance. Party B is responsible for providing: medical dental vision care insurance. The costs of medical/dental/vision care expenses not paid by insurance shall be shared as follows: Party A % Party B %. 251 Superior Court of Arizona in Maricopa County DRMC78f- 010119 ALL RIGHTS RESERVED Page 2 of 4 American LegalNet, Inc. www.FormsWorkFlow.com Case No. Even though the Court222s judgment contains orders regarding medical insurance and the allocation of the right to claim the child as a dependent for the purposes of federal taxes, these orders are not binding on the IRS. Under the Affordable Care Act, the parent who claims a child as a dependent on a federal tax return has the obligation to ensure that the child is covered by medical insurance and may be penalized by the IRS for failing to do so. This penalty may be imposed even if it is the other parent222s responsibility to carry health insurance on the child under the Divorce Decree. D. TAX DEDUCTIONS. The Court allocates the federal tax exemption(s) for the dependent child(ren) as follows: Child222s Name Date of Birth (Month, Day, Year) Party Entitled to Deduction For Calendar Party A Party B Party A Party B Party A Party B For years following those listed above while this Child Support Order remains in effect, the parties shall repeat the pattern above of claiming deductions for each child. E. OTHER ORDERS. This Court makes further Orders relating to this matter as follows: DONE IN OPEN COURT: JUDGE OR COURT COMMISSIONER ORDER MODIFYING LEGAL DECISION-MAKING (LEGAL CUSTODY), PARENTING TIME, and SUPPORT, or PARENTING TIME and SUPPORT Do not write or sign below this line until you are instructed to do so by Clerk of Superior Court or Notary. 251 Superior Court of Arizona in Maricopa County DRMC78f- 010119 ALL RIGHTS RESERVED Page 3 of 4 American LegalNet, Inc. www.FormsWorkFlow.com Case No. OATH OR AFFIRMATION OF THE PARTIES By signing this Agreement, I/We: Waive the right to trial on this matter. Acknowledge reading and understanding the terms of this stipulation and agree to the terms of the attached Order. Entering this agreement voluntarily and not due to any threat of force or harm, duress, undue influence or coercion from anyone, including the other party. Swear or affirm the information provided is true and correct, under penalty of perjury. SIGNATURES Party A222s Signature Party B222s Signature STATE OF COUNTY OF Subscribed and sworn to or affirmed before me this: (date) By . Deputy Clerk or Notary Public (notary seal) STATE OF COUNTY OF Subscribed and sworn to or affirmed before me this: (date) By . Deputy Clerk or Notary Public (notary seal) If the State of Arizona is a party to your case, a representative of the Attorney General222s Division of Child Support Enforcement (DCSE) must also sign before you file. (See Instructions) Signature of Attorney General222s representative Date (Attorney Signatures 226 if applicable) P arty A 222s Attorney222s: Party B 222s Attorney222s: 251 Superior Court of Arizona in Maricopa County DRMC78f- 010119 ALL RIGHTS RESERVED Page 4 of 4 American LegalNet, Inc. www.FormsWorkFlow.com