Name: Mailing Address: City, State, Zip Code: Day/Evening Phone: Representing: State Bar Number (if Atty.): Self Petitioner Respondent FOR CLERK’S USE ONLY SUPERIOR COURT OF ARIZONA IN MARICOPA COUNTY Case No. Petitioner ATLAS No. REQUEST FOR ORDER GRANTING OR DENYING A CUSTODY HEARING Respondent A.R.F.L.P. 91(D)(5) A petition to modify custody was filed on this date: and the (Month/Day/Year) “Petition” and “Notice of Filing Petition to Modify Child Custody” were served on the date below: Twenty-five (25) days (or more) have passed since service. (Month/Day/Year) I hereby request the Court issue an order granting or denying a custody hearing on this matter. A copy of this request has already been sent or delivered to the other party and to the assigned Judge or will be sent or delivered today. I state to the Court under penalty of perjury that the contents of this document are true and correct to the best of my knowledge and belief. Date Signature ©Superior Court of Arizona June 28, 2007 ALL RIGHTS RESERVED Page 1 of 1 DRMC16f Use current version RCH American LegalNet, Inc. www.FormsWorkflow.com