251 Superior Court of Arizona in Maricopa County DRP14f-010119 ALL RIGHTS RESERVED Page 1 of 2 Use only most current version 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 PRELIMINARY INJUNCTION AND A.R.S. 24725-808 Name of Respondent/Party B A. INFORMATION about this PRELIMINARY INJUNCTION 1. If filing for Legal Decision-Making and Parenting Time, and you want the Court to issue a Preliminary Injunction, you must file at least ONE of the following papers with the Petition: (check box to indicate which is attached) A Copy of the Birth Certificate that lists FATHER as a parent of the child subject of this petition, or An Affidavit or Acknowledgement signed by the FATHER admitting paternity, or An Adoption Order listing BOTH PARTIES as parents, or A Court Order establishing paternity. 2. ACTIONS FORBIDDEN by this Court Order: BOTH the Petitioner and the Respondent shall not do any of the following: You may not molest, harass, disturb the peace of or commit an assault or battery on the person of the other party or any natural or adopted child of the parties, AND You may not remove any natural or adopted child of the parties then residing in this state from the jurisdiction of the court without the prior written consent of the parties or the permission of the court, AND You may not remove or cause to be removed any child of the parties from any existing insurance coverage, including medical, hospital, dental, automobile, or disability insurance. WARNING: This is an official Court Order. If you disobey this order the court may find you in contempt of court. You may also be arrested and prosecuted for the crime of interfering with judicial proceedings and any other crime you may have committed in disobeying this order. You or the other party may file a certified copy of this order with your local law enforcement agency. A certified copy may be obtained from the clerk of the court that issued this order. If you are the person who brought this action, you must also file evidence with the law enforcement agency that this order was served on the other party. This court order is effective until a final order of paternity, legal decision-making or parenting time is filed or the action is dismissed. American LegalNet, Inc. www.FormsWorkFlow.com Case No. 251 Superior Court of Arizona in Maricopa County DRP14f-010119 ALL RIGHTS RESERVED Page 2 of 2 Use only most current version 3. REQUIREMENTS of this Court Order: Arizona Law, A.R.S. 24725-808(B)(2) requires: Both Petitioner and Respondent must maintain ALL INSURANCE COVERAGE in full force and effect during the Petition process. 4. This PRELIMINARY INJUNCTION: Does not prejudice the rights of the parties or of any child that are to be adjudicated at the subsequent hearings in the proceeding. May be revoked or modified before the final decree on a showing by affidavit of the facts necessary for revocation or modification of a final decree. Terminates when the final order is entered or when the Petition is dismissed. B. DESCRIPTION OF THE PARTIES: 1. Petitioner: Name: Gender: Male Female Height: Weight: last 4 nos.) Date of Birth: 2. Respondent: Name: Gender: Male Female Height: Weight: (last 4 nos.) Date of Birth: C. OFFICIAL SIGNATURE: GIVEN UNDER MY HAND AND THE SEAL OF THE COURT this day of , . CLERK OF SUPERIOR COURT By: , Deputy Clerk American LegalNet, Inc. www.FormsWorkFlow.com