Name of Person Filing: In this case I am: Petitioner Respondent In this case I am: Representing Myself (No Attorney), or If Represented by Attorney: Attorney Bar Number: My Address (if not protected): City, State, Zip Code: Telephone Numbers: For Clerk’s Use Only SUPERIOR COURT OF ARIZONA IN MARICOPA COUNTY Case Number: Petitioner (in original case) ATLAS Number: PETITION TO MODIFY CHILD CUSTODY, PARENTING TIME and CHILD SUPPORT Respondent (in original case) I, (print your name) am the Petitioner or Respondent and make the following statements to the Court: GENERAL INFORMATION: 1. Information about Me Name: Address: How I am related to minor child(ren) for whom the CUSTODY/PARENTING TIME order should be changed: Mother or Father 2. Information about the Other Party(ies) Name: Address: How the other party is related to minor child(ren) for whom the CUSTODY/PARENTING TIME order should be changed: Mother or Father 3. Information About the Minor Child(ren) for whom I want the order changed: Name: Birth Date: Age: Name: Birth Date: Age: Name: Birth Date: Age: Name: Birth Date: Age: © Superior Court of Arizona in Maricopa County July 9, 2008 ALL RIGHTS RESERVED PTT DRMC11f Page 1 of 4 Use most current version American LegalNet, Inc. www.FormsWorkflow.com Case No. 4. Affidavit Regarding Minor Children. The minor children have resided in Arizona since the I have attached an “Affidavit Regarding Minor entry of the last Arizona Custody Order or (if not) Children”. 5. Information about the Order I want to change: The Order was issued on: (Month/Day/Year) The Order was issued by: (Name of Court) Located in this County: Located in this State: And each of the following is a true statement: • The minor child(ren) have lived in Arizona for at least six (6) months before the date I am filing this Petition or since birth, if younger than six (6) months. • If the Order was not issued by the Superior Court of Arizona in this county, the case has already been transferred to this county and has a Maricopa County case number. WHAT THE ORDER NOW SAYS: Put in WORD FOR WORD the part of the decree/order you want to change. (Use extra paper if necessary) 6. DOMESTIC VIOLENCE. (If you are requesting a change to joint custody, there must not be “significant” domestic violence. A.R.S. 25-403.03) No significant domestic violence has occurred or 7. domestic violence has occurred. Explain: WHY THE DECREE/ORDER SHOULD BE CHANGED: These are my reasons why I believe that a change of custody and/or parenting time is in the best interest of the child(ren) (Use extra pages if necessary): 8. MEDIATION / ADR (Alternative Dispute Resolution) REQUIREMENTS IN PRIOR ORDER: The current Court Order does not require the parties to pursue Mediation or ADR before filing to modify custody or parenting time. OR The current Court Order does require the parties to pursue Mediation or ADR before filing to modify custody or parenting time, and this is what I/we have done to comply with that requirement:(next page) © Superior Court of Arizona in Maricopa County July 9, 2008 ALL RIGHTS RESERVED PTT DRMC11f Page 2 of 4 Use most current version American LegalNet, Inc. www.FormsWorkflow.com Case No. REQUESTS I MAKE TO THE COURT: A. CUSTODY AND PARENTING TIME. Joint Legal Custody. I want the mother and father to be awarded joint legal custody of the minor child(ren) (name(s) of minor child(ren)) subject to a Parenting Plan to be submitted later. OR Sole custody. Sole custody of (name(s) of minor child(ren)) should be awarded to Mother or Father and/or Sole custody of (name(s) of child(ren)) should be awarded to Father, subject to parenting time as follows: 1. Mother Reasonable parenting time to the parent who does not have custody according to the Maricopa County Parenting time Guidelines; OR Reasonable parenting time to the parent/party who does not have custody according to the attached Parenting Plan; OR Supervised parenting time but only in the presence of another person; OR No parenting time rights to Mother or Father Supervised parenting time or no parenting time is requested for the following reasons: 2. 3. 4. B. CHILD SUPPORT. C. MEDICAL, DENTAL, VISION CARE Mother or Father should pay child support to Mother or Father in the per month on the first day of every month, beginning the first day of amount of $ month following the filing of this Petition based upon the attached “Child Support Worksheet.” All child support payments should be made through the Child Support Clearinghouse, and will be subject to an applicable statutory fee through an automatic Order of Assignment. Mother should be responsible for providing: Father should be responsible for providing: medical medical dental dental vision care insurance. vision care insurance. Medical, dental, and vision care insurance, payments and expenses are based on the information in the Parent’s Worksheet for Child Support 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. Petitioner is ordered to pay __________ %, AND Respondent 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. D. FEDERAL INCOME TAX DEDUCTION. The right to claim the minor child(ren)ren as a deduction for Federal income tax purposes should be divided as follows: Person entitled to claim: “M” for Mother, “F” for Father. Claim by: Name of Child Starting Tax Year: Every Year Every Other M F Every Year Every Other M F M M Every Year Every Year F F Every Other Every Other Case No. © Superior Court of Arizona in Maricopa County July 9, 2008 ALL RIGHTS RESERVED PTT DRMC11f Page 3 of 4 Use most current version American LegalNet, Inc. www.FormsWorkflow.com E. F. OTHER ORDERS. I request further Orders relating to this matter as follows: OATH OR AFFIRMATION I swear or affirm that the information on this document is true and correct under penalty of perjury. Signature Date Printed Name © Superior Court of Arizona in Maricopa County July 9, 2008 ALL RIGHTS RESERVED PTT DRMC11f Page 4 of 4 Use most current version American LegalNet, Inc. www.FormsWorkflow.com