Person Filing: Address (if not protected): City, State, Zip Code: Telephone: Email Address: Lawyer's Bar Number: Representing Self, without a Lawyer or Attorney for Petitioner OR FOR CLERK'S USE ONLY Respondent SUPERIOR COURT OF ARIZONA IN MARICOPA COUNTY JUVENILE COURT In the Matter of: Case No: JS (To be completed by the Court) PETITION FOR TERMINATION OF PARENT-CHILD RELATIONSHIP (SEVERANCE of PARENTAL RIGHTS) A.R.S. § 8-531-544 (Full Legal Names of Minor Children) 1. INFORMATION ABOUT PETITIONER: Name: Birth Date: Address: Relationship to children: 2. INFORMATION ABOUT PARENT(S): a. Mother's name: Mother's birth date: Mother's address: b. Father's name: Father's birth date: Father's address: (If more than one father involved, please attach same information for all fathers) © Superior Court of Arizona in Maricopa County ALL RIGHTS RESERVED JS12f - 031616 Page 1 of 6 American LegalNet, Inc. www.FormsWorkFlow.com Case No. ____________________ 3. INFORMATION ABOUT THE CHILDREN: a. Child's name: Child's birth date: Child's birth place: Child's address: male female b. Child's name: Child's birth date: Child's birth place: Child's address: male female c. Child's name: Child's birth date: Child's birth place: Child's address: male female d. Child's name: Child's birth date: Child's birth place: Child's address: (If more than four children, please attach information for all children) 4. male female The person or agency currently having legal custody, guardianship, acting in loco parentis (acting as parent) or providing care for the children is: Name: Address: © Superior Court of Arizona in Maricopa County ALL RIGHTS RESERVED JS12f - 031616 Page 2 of 6 American LegalNet, Inc. www.FormsWorkFlow.com Case No. ____________________ 5. Will you or any person required to receive notice need a court interpreter? If "Yes", Person's name: Yes No Language(s) needed Person's name: Language(s) needed Person's name: Language(s) needed 6. Jurisdiction in Arizona is proper because the child or children are present in Arizona Yes No If the child or children are not present in Arizona, jurisdiction in Arizona is proper because: 7. Have there been any prior court cases concerning the children? If yes, list the name of the Court and the case number(s) Yes No 8. Is any parent or child an enrolled member of any native American tribe or nation? Yes No Uncertain If "yes" or "uncertain", please explain: INSTRUCTIONS: Check all the allegations below that you believe apply. If seeking to terminate the rights of more than one parent, attach a separate sheet for the additional parents. If more space is needed for any answer, please attach additional information. 9. The Court should terminate the parent-child relationship between the children and the Father Mother based on the following grounds: Abandonment: The parent has abandoned the children by failing to provide reasonable support and failing to maintain regular contact with the children, including normal supervision. © Superior Court of Arizona in Maricopa County ALL RIGHTS RESERVED JS12f - 031616 Page 3 of 6 American LegalNet, Inc. www.FormsWorkFlow.com Case No. ____________________ Please state the facts supporting this statement: Neglect/Abuse: The parent has neglected or willfully abused a child. Please state the facts supporting this statement: Incapacity: The parent is unable to discharge the parental responsibilities because of mental illness, mental deficiency or a history of chronic abuse of dangerous drugs, controlled substances or alcohol and there are reasonable grounds to believe that the condition will continue for a prolonged, indeterminate period. Please state the facts supporting this statement: Criminal Conviction The parent is deprived of civil liberties due to the conviction of a felony the nature of which proves the unfitness of that parent to have future custody and control of the children. Please state the facts supporting this statement: The parent is deprived of civil liberties due to the conviction of a felony and the sentence of that parent is of such length that the children will be deprived of a normal home for a period of years. Please state the facts supporting this statement: © Superior Court of Arizona in Maricopa County ALL RIGHTS RESERVED JS12f - 031616 Page 4 of 6 American LegalNet, Inc. www.FormsWorkFlow.com Case No. ____________________ Paternity The potential father failed to file a paternity action within thirty (30) days of completion of service of notice as prescribed by A.R.S. § 8-106(G). The putative father (one who registered with the state claiming to be the father) failed to file a notice of claim of paternity as prescribed in A.R.S. § 8-106.01. Relinquishment or Consent The parent has relinquished his or her right to the children to an agency or has consented to the adoption. I have attached to this Petition a copy of all applicable relinquishment(s) or consent(s). Identity Unknown The identity of the parent is unknown and continues to be unknown following three months of diligent efforts to identify and locate the parent. Please state the facts supporting this statement: Other Parental rights should be terminated for other grounds under A.R.S. § 8-533 as follows: Please state the facts supporting this statement: 10. Best Interests It is in the children's best interest to have rights terminated. Please state the facts supporting this statement: Father's Mother's © Superior Court of Arizona in Maricopa County ALL RIGHTS RESERVED JS12f - 031616 Page 5 of 6 American LegalNet, Inc. www.FormsWorkFlow.com Case No. ____________________ 11. Social Study The social study discussed in A.R.S. § 8-536(A) will be completed by the following agency: I request the social study discussed in A.R.S. § 8-536(A) be waived in the best interest of the children for the following reasons: RELIEF REQUESTED: Based on the information above, after notice and a hearing Petitioner requests the Court issue an order which: Terminates the parent-child relationship between the children and their: Father Mother, and Appoints as guardian of the children and vests legal custody of the children in: Orders that the parent(s) whose rights are terminated shall remain obligated for child support payments until an adoption order is entered and shall remain obligated for arrearages; Orders that: (state any other relief requested); and Any other such orders as the Court deems just and proper. I DECLARE UNDER PENALTY OF PERJURY THAT THE INFORMATION PR