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 Regarding the Matter of: Case No. PETITION TO ESTABLISH (Name of Petitioner/Party A) PARENTING TIME AND (Name of Respondent/Party B) STATEMENTS THE COURT, UNDER OATH OR AFFIRMATION 1. INFORMATION ABOUT ME: Name: Address : Date of Birth : Occupation: My relationship to children for whom I want the Primary Residence, Legal Decision-Making and Parenting Time (or Parenting Time and Child Support) Order: Mother Father Other. My relation to the child ( ren ) is: FOR CLERK222S USE ONLY 251 Superior Court of Arizona in Maricopa County DRV11f - 020618 ALL RIGHTS RESERVED Page 1 of 6 American LegalNet, Inc. www.FormsWorkFlow.com Case No. 2. INFORMATION ABOUT OTHER PARTY: Name: Address : Date of Birth : Occupation : Other Party222s relationship to children for whom I want the Primary Residence, Legal Decision-making and Parenting Time (or Parenting Time and Child Support) Order: Mother Father Other. Other Party222s relation to the children is: 3. WHY I AM FILING THIS COURT CASE IN ARIZONA AGAINST THE OTHER PERSON: (check one or more boxes that are true) The person is a resident of Arizona I believe that I will personally serve the person in Arizona (see packet on service to know about this) The person agrees to have the case heard here and will file written papers in the court case; The person lived with the minor child in this state at some time; The person lived in this state and provided pre-birth expenses or support for the minor child; The minor child lives in this state as a result of the acts or directions of the person; The person had sexual intercourse in this state as a result of which the minor child may have been conceived; The person signed an acknowledgment of paternity that is filed in this state; The person did any other acts that substantially connect the person with this state (see a lawyer to help you determine this). 4. INFORMATION ABOUT MINOR CHILD(REN) FOR WHOM I WANT THE PARENTING TIME ORDER: Name Name: Birth date Birth date: Current Address: Current Address: County of residence: County of residence: Name Name: Birth date Birth date: Current Address: Current Address: County of residence: County of residence: 251 Superior Court of Arizona in Maricopa County DRV11f - 020618 ALL RIGHTS RESERVED Page 2 of 6 American LegalNet, Inc. www.FormsWorkFlow.com Case No. *NOTE: If married when minor child(ren) born, conceived or adopted, and no decree of Divorce or Separation has been issued, STOP! Do not use these forms unless advised to do so by an attorney. Requests for parenting time and authority for legal decision-making (custody) must generally be filed as part of a case for Separation or Divorce. 5. PATERNITY WAS ESTABLISHED BY: (check one box). (A copy of any Order or document referenced here should already be in the Court file or attached.) A Court Order for Paternity from this county or previously transferred to this county stating that is the natural father of minor child(ren). (A.R.S. 247 25-502(c)) Both parents signing an Acknowledgment of Paternity through the Hospital Paternity Program or other means provided by law after July 18, 1996, and a birth certificate listing the name of the father was issued as a result. (A.R.S. 247 36-334) We do not have an order of paternity, but we do have a child support order. (See instructions) Parties were legally married when minor child(ren) was (were) born, conceived or adopted.* 6. INFORMATION ABOUT CHILD SUPPORT FOR CHILDREN: An Order for Child Support is dated from (name of court) which states that child support is established. Note: if order is from court other than Superior court in Maricopa County. (See instructions) Other information about the children: 7. WHERE THE CHILDREN WHO ARE UNDER 18 YEARS OLD HAVE LIVED FOR THE LAST 5 YEARS. (Attach extra pages if necessary.) Child's Name: Dates: From To Lived with: Relationship to child: Street address: City, State: Child's Name: Dates: From To Lived with: Relationship to child: Street address: City, State: Child's Name: Dates: From To Lived with: Relationship to child: Street address: City, State: 251 Superior Court of Arizona in Maricopa County DRV11f - 020618 ALL RIGHTS RESERVED Page 3 of 6 American LegalNet, Inc. www.FormsWorkFlow.com Case No. 8. COURT CASES INVOLVING PHYSICAL CUSTODY, LEGAL DECISION-MAKING (LEGAL CUSTODY) OR PARENTING TIME RELATED TO THE CHILDREN UNDER 18 YEARS OLD: (check one box) I HAVE I HAVE NOT been a party or a witness in court in this state or any other state involving the legal decision-making (custody) or parenting time of any of the minor children named above (If so, explain below, using extra pages if necessary. IF NOT, GO ON.) Name of each child: Court State: Court location (county/city): Court case number: Current case status: How the minor children are involved: Summary of any Court Order: 9. COURT CASES NOT INVOLVING PHYSICAL CUSTODY, LEGAL DECISION- MAKING (LEGAL CUSTODY) OR PARENTING TIME RELATED TO CHILDREN UNDER 18 YEARS OLD: (Check one box) I HAVE I DO NOT HAVE information regarding any court action in this state or any other state involving the minor child(ren) listed above that could affect this case including court cases for enforcement and relating to domestic violence, protective orders, termination of parental rights and adoptions (If you have, explain below, using extra pages if necessary. IF NOT, GO ON.) Name of each child: Court State: Court location (county/city): Court case number: Current case status: Nature (type) of co urt proceeding: Summary of any Court Order: 251 Superior Court of Arizona in Maricopa County DRV11f - 020618 ALL RIGHTS RESERVED Page 4 of 6 American LegalNet, Inc. www.FormsWorkFlow.com Case No. 10. PHYSICAL CUSTODY, LEGAL DECISION-MAKING (LEGAL CUSTODY) OR PARENTING TIME CLAIMS OF ANY PERSON: (check one box) I DO NOT KNOW I DO KNOW a person other than the Party A or the Party B who has physical custody or who claims legal decision-making authority (legal custody) or parenting time rights to any of the minor children named above. (If so, explain below, using extra pages if necessary. IF NOT, GO ON). Name of each child: Name of Person with the claim: Address of Person with the claim: Nature of the Claim: OTHER STATEMENTS TO THE COURT: 11. DOMESTIC VIOLENCE (Check here if the following is true): Domestic Violence has not occurred between the parties. 12. VENUE: This is the proper court to bring this lawsuit under Arizona law because it is the county of residence of Party A, and/or Party B, and/or the child(ren). REQUESTS I MAKE TO THE COURT: 1. AWARD PARENTING TIME AS FOLLOWS: (Check only one.) Reasonable parenting time rights as described in the Parenting Plan Supervised parenting time between the children and Party A OR Party B, No parenting time rights to Party A OR Party B. 251 Superior Court of Arizona in Maricopa County DRV11f - 020618 ALL RIGHTS RESERVED Page 5 of 6 American LegalNet, Inc. www.FormsWorkFlow.com Case No. 2. (IF you requested either 223Supervised or No parenting time224 above, explain.) Supervised or no parenting time is in the best interests of the child(ren), because: * Explanation continues on attached pages made part of this document by reference. a. Name this person to supervise: (If applicable) b. Restrict parenting time as follows: c. Order cost of supervised parenting time (if applicable) to be paid by: Party A Party B, OR Shared equally by the parties. 3. OTHER ORDERS: OTHER: (Explain specifically): UNDER OATH OR BY AFFIRMATION I swear or affirm under penalty of perjury that the contents of this document are true and correct to the best of my knowledge and belief. Date Signature STATE OF COUNTY OF Subscribed and sworn to or affirmed before me this: by (date) . (notary seal) Deputy Clerk or Notary Public 251 Superior Court of Arizona in Maricopa County DRV11f - 020618 ALL RIGHTS RESERVED Page 6 of 6 American LegalNet, Inc. www.FormsWorkFlow.com