251 Superior Court of Arizona in Maricopa County Page 1 of 4 DRMV83f-010119 ALL RIGHTS RESERVED Person Filing: Address (if not protected): City, State, Zip Code: Telephone: Email Address: ATLAS Number: Representing Self, without a Lawyer or Attorney for Petitioner OR Respondent SUPERIOR COURT OF ARIZONA IN MARICOPA COUNTY Case No . Petitioner/Party A, (in original case) ATLAS No. and ORDER MODIFYING PARENTING TIME or PARENTING TIME and CHILD SUPPORT D E R M O D I F Y I N G L E G A L D E C I S I O N - M A K I N G Respondent/Party B (in original case) THE COURT FINDS: 1. This case has come before this court on a The court has taken all testimony needed to enter a final Order. 2. This court has jurisdiction to change parenting time and/or support, and has jurisdiction over the parties under the law. 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 parenting time and/or support. 3. This Order applies to the following minor children: NAME(S) DATES OF BIRTH /AGE (Month/Day/Year) 4. GROUNDS FOR CHANGING PARENTING TIME OR PARENTING TIME AND SUPPORT. (Check one box and describe why the change is in the best interest of the minor child(ren).) There have been substantial, significant and continuing changes in circumstances that make a change in parenting time and/or child support in the best interest of the minor child(ren) for the reasons described below: OR American LegalNet, Inc. www.FormsWorkFlow.com Case Number: 251 Superior Court of Arizona in Maricopa County Page 2 of 4 DRMV83f-010119 ALL RIGHTS RESERVED One party has not followed the Order and a change in parenting time and/or child support is in the best interest of the minor child(ren) for the reasons described below. OR There has been domestic violence, spousal abuse, or child abuse as described below since the date of the earlier Order, and it is in the best interest of the minor child(ren) that the change is made for the reasons described below: (Include a description of the domestic violence.) OR It is in the best interest of the minor child(ren) that no change to parenting time and/or support is made at this time for the reasons described below. REASONS: (Describe why a change in parenting time and/or support is or is not in the best interest of the minor child(ren).) 5. SUPERVISED OR NO PARENTING TIME -parent): (if applicable) Supervised parenting time between the minor child(ren) and Party A or Party B or Other, or no parenting time by Party A or Party B or Other is in the best interests of the minor child(ren) for the following reasons: THE COURT ORDERS: The Order regarding parenting time and/or support dated is changed as follows: A. PARENTING TIME: 1. Reasonable parenting time to the parent who does not have custody according to the Maricopa County Parenting Time Guidelines. (OR) 2. Reasonable parenting time to the parent who does not have custody according to the Parenting Plan attached. (OR) 3. Supervised parenting time but only in the presence of another person, who is named below or otherwise approved by the Court: Name of supervisor : American LegalNet, Inc. www.FormsWorkFlow.com Case Number: 251 Superior Court of Arizona in Maricopa County Page 3 of 4 DRMV83f-010119 ALL RIGHTS RESERVED The cost of supervised parenting time shall be paid by: Party A or Party B or Other shared equally by the parties, or as follows: Restrictions on parenting time: (OR) 4. No parenting time rights to Party A or Party B or Other 5. Other parenting time -parent) (explain): B. CHILD SUPPORT: Child Support is unchanged, or Party A shall pay child support to Party B or to Other in the amount of $ . Party B shall pay child support to Party A or to Other in the amount of $ . per month, payable on the first day of each month, beginning the first day of month following the signing of this Order. All child support payments shall be made through the Support Payment Clearinghouse by the attached Income Withholding Order, and shall include an additional statutory fee for processing. Child Support is based on the information in the Child Support Worksheet attached hereto and incorporated by reference, and the Arizona Child Support Guidelines, OR CHILD SUPPORT DEVIATION. The court, having considered the best interests of the minor child(ren), deviates from the Guidelines for the following reasons. (Describe reasons.) American LegalNet, Inc. www.FormsWorkFlow.com Case Number: 251 Superior Court of Arizona in Maricopa County Page 4 of 4 DRMV83f-010119 ALL RIGHTS RESERVED C. MEDICAL, DENTAL, VISION CARE. Party A is responsible for providing: medical dental vision care insurance. Party B is responsible for providing: medical dental vision care insurance. Other Party is responsible for providing: medical dental vision care insurance. Medical, dental, and vision care insurance, payments and expenses are based on the information in the Child Support Worksheet attached and incorporated by reference. The party ordered to pay must keep the other party informed of the insurance company name, address and telephone number, and must give the other party the documents necessary to submit insurance claims. Non-Covered Expenses. Party A is ordered to pay %, AND Party B is ordered to pay % of all reasonable uncovered and/or uninsured medical, dental, vision care, prescription and other health care charges for the minor child(ren), including co-payments. ding 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 the child under the Divorce Decree. D. FEDERAL INCOME TAX DEDUCTION. Date of Birth (Month, Day, Year) Parent Entitled to Deduction For Calendar Year Party A Party B 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: F. FINAL APPEALABLE ORDER. Pursuant to Arizona Rules of Family Law Procedure, Rule 78, this final judgment/decree is settled, approved and signed by the court and shall be entered by the clerk. DONE IN OPEN COURT: . JUDGE OR COURT COMMISSIONER American LegalNet, Inc. www.FormsWorkFlow.com