251 Superior Court of Arizona in Maricopa County Page 1 of 1 DRMW31f 010119 ALL RIGHTS RESERVED RHS Person Filing: (1) 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 (2) Case No: (3) Name of Petitioner / Party A (in original case) ATLAS No: (3) (if applicable) (2) Name of Respondent / Party B (in original case) PETITION FOR HEARING The information provided on the Modify the Income Withholding Order is not accurate. I request that a hearing be set so that I can explain to the Judge or Commissioner my position. I have read this document and the information is true and correct to the best of my knowledge. (4) Signature Date Printed Name NOTICE: Upon filing the Petition for Hearing, the filing party must immediately mail or otherwise deliver a copy of this Petition to the other party or his/her attorney. If either party is currently using or has used the State IV-D Agency for child support services (Division of Child Support Enforcement or their representative), the State must also be mailed or provided with a copy of the Request, which can be mailed to: Office of the Attorney General Child Support Services Section 2005 N. Central Avenue Mail Drop 7611 Phoenix, AZ 85004 If a hearing or conference is scheduled, the court may enter a judgment for past- costs, other court costs, and/or attorney fees. American LegalNet, Inc. www.FormsWorkFlow.com