(1) Name of Person Filing Petition Mailing Address City, State, Zip Daytime/Evening Phone ATLAS Number (if applicable) In this case I am Plaintiff Respondent Attorney Name Represented by Attorney Bar No. FOR CLERK’S USE ONLY SUPERIOR COURT OF ARIZONA IN MARICOPA COUNTY (2) (3)CASE NO: Name of Petitioner (in original case) PETITION FOR EX PARTE ORDER OF ASSIGNMENT A.R.S. §25-504 Name of Respondent (in original case) On (4) (date),(5) pay support, was ordered in (6) Court”) in (7) (8) $ $ $ $ , the person ordered to (name of court, example: “Superior (location of court: county and state) to pay: monthly child support payment monthly spousal maintenance payment monthly child support arrearage payment monthly spousal maintenance arrearage payment (9) I request that an Ex Parte Order of Assignment be issued because: (check all that apply) I am the person entitled to the support or I represent the agency entitled to collect the support, and there is no existing order of assignment. A past due obligation exists for child support, spousal support, spousal support arrears or interest and I per month request payment on past due support in the amount of $ I am the person required to pay the support and there is no existing order of assignment, and I hereby voluntarily request an order of assignment be issued for payment of my obligation. STATE OF ARIZONA County of Maricopa ) ) ss. Subscribed and sworn or affirmed and acknowledged before me this date: Notary Expiration Date Notary Public or Clerk Dated (10) Signature of person requesting Assignment Name of Agency if Applicable © Superior Court of Arizona in Maricopa County August 9, 2007 ALL RIGHTS RESERVED DRWA11f Page 1 of 1 Use most current version WAH American LegalNet, Inc. www.FormsWorkflow.com