251 Superior Court of Arizona in Maricopa County Page 1 of 5 DRMV11f-010119 ALL RIGHTS RESERVED PTT Person Filing: 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 Case Number: Name of Petitioner/Party A (in original case) PETITION TO MODIFY PARENTING TIME or PARENTING TIME AND CHILD SUPPORT Name of Respondent/Party B (in original case) I, am the Party A or Party B or Other Party (print your name) and make the following statements to the Court: GENERAL INFORMATION: 1. Information about Me, the person filing (requesting) this modification: Name: Address: How I am related to minor child(ren) for whom the PARENTING TIME order should be changed: Mother or Father or Other: (explain) 2. Information about Other Party: (if the party filing this modification is one of the parents.) (If someone other than one of the parents is filing this request, then list the information about one of the parents, then the information about the other parent below.) Name: Address: How this party is related to minor child(ren) for whom the PARENTING TIME order should be changed: Mother or Father or Other: (explain) American LegalNet, Inc. www.FormsWorkFlow.com Case Number: 251 Superior Court of Arizona in Maricopa County Page 2 of 5 DRMV11f-010119 ALL RIGHTS RESERVED Information about the Other Parent or Other Party (if there is a non-parent involved the case other than the person whose information has already been listed in (1) above): Name: Address: How this party is related to minor child(ren) for whom the PARENTING TIME order should be changed: Mother or Father or Other: (explain) 3. Information About the Minor Child(ren) for whom I want the Order changed: Name: Name: Birth Date: Age: Birth Date: Age: Name: Name: Birth Date: Age: Birth Date: Age: n for all. 4. Affidavit Regarding Minor Children. The minor children have resided in Arizona since the entry of the last Arizona Legal Decision Making (Custody) Order or (if not) I have attached an . 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: (Name of County) Located in this State: (Name of State) The order I wish to change is on page , section/paragraph of the Order identified abo ve. E ach 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. American LegalNet, Inc. www.FormsWorkFlow.com Case Number: 251 Superior Court of Arizona in Maricopa County Page 3 of 5 DRMV11f-010119 ALL RIGHTS RESERVED WHAT YOUR ORDER NOW SAYS: Explain the part of the decree/order you want to change. (Use extra paper if necessary) 6.DOMESTIC VIOLENCE. No significant domestic violence has occurred, or domestic violence has occurred. Explain: 7. WHY THE DECREE/ORDER SHOULD BE CHANGED: These are my reasons why I believe that a change of parenting time is in the best interest of the minor child(ren) (Use extra pages if necessary): REQUESTS I MAKE TO THE COURT: A. PARENTING TIME to the Party A or Party B or Other (non-parent) 1. Reasonable parenting time to the parent/party who does not have custody according to theMaricopa County Parenting Time Guidelines; OR 2. Reasonable parenting time to the parent/party who does not have custody according to theattached Parenting Plan; OR 3. Supervised parenting time but only in the presence of another person; OR 4. No parenting time rights to Part A or Part B or OtherSupervised parenting time or no parenting time is requested for the following reasons: American LegalNet, Inc. www.FormsWorkFlow.com Case Number: 251 Superior Court of Arizona in Maricopa County Page 4 of 5 DRMV11f-010119 ALL RIGHTS RESERVED (Only use this section below if needed because there is a 3rd (third) party in addition to the parents involved in this case) PARENTING TIME to the Party A or Party B or Other non-parent) as follows: 1. Reasonable parenting time to the parent/party who does not have custody according to theattached Parenting Plan; OR 2. Supervised parenting time but only in the presence of another person; OR 3. No parenting time rights to Part A or Part B or OtherSupervised parenting time or no parenting time is requested for the following reasons: The costs of travel related to parenting time/visitation over 100 miles one way shall be shared as follows: Party A % Party B % B. CHILD SUPPORT. Party A or Party B should pay child support to Party A or Party Bor to Other party in the amount of $ per month on the first day of every month, beginning the first day of month following the filing of this Petition based upon the attached All minor child(ren) support payments should be made through the Support Payment Clearinghouse, and will be subject to an applicable statutory fee through an automatic Order of Assignment. Title IV-D program or Temporary Assistance for Needy Families (TANF) Programs: Does not apply. Party A Party B is applying for or currently receiving TANF or services from the Arizona Title IV-D program. NOTE: If one or both of the parties is or will be receiving TANF or Title IV-D support, you must obtain the Attorney General or county attorney approval by signature on the Final decree BEFORE you file it. (Rule 45(c)(3)) C. MEDICAL, DENTAL, VISION CARE. Par ty A should be responsible for providing: medical dental vision care insurance. Par ty B should be responsible for providing: medical dental vision care insura nce. Party A and Party B will pay for all reasonable unreimbursed medical, dental, and health-related expenses incurred for the minor child(ren) in proportion to their respective incomes. American LegalNet, Inc. www.FormsWorkFlow.com Case Number: 251 Superior Court of Arizona in Maricopa County Page 5 of 5 DRMV11f-010119 ALL RIGHTS RESERVED D. FEDERAL INCOME TAX DEDUCTION. Date of Birth (Month, Day, Year) Par ty Entitled For Calendar to Deduction Year Par ty A Par ty B Par ty A Par ty B Par ty A Par ty B Par ty A Par ty B For years following those listed above while this Child Support Order remains in effect, the parties shall repeat the pattern above of claiming deductions for each minor child. E. OTHER ORDERS. I request further Orders relating to this matter as follows: 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: (date) b y . ( N otary seal) Deputy Clerk or Notary Public American LegalNet, Inc. www.FormsWorkFlow.com