Name of Person Filing: Your Address: Your City, State, Zip Code: Your Telephone Number: ATLAS Number (if applicable): Attorney Bar Number (if applicable): Representing Self (Without a lawyer) OR Attorney for (A) For clerk use only SUPERIOR COURT OF ARIZONA MARICOPA COUNTY (B) Case Number: (C) Name of Petitioner RESPONSE TO CHILD SUPPORT INFORMATION FORM Name of Respondent STATEMENTS TO THE COURT, UNDER OATH: 1. INFORMATION ABOUT MY SPOUSE, the Petitioner: Name: Address: Social security number: Job Title: Employer’s Name: Employer’s Address: 2. Date of Birth: INFORMATION ABOUT ME, the Respondent: Name: Address: Social security number: Job Title: Employer’s Name: Employer’s Address: 3. Date of Birth: INFORMATION ABOUT MARRIAGE: Date of Marriage: 4. INFORMATION ABOUT YOUR CHILD(REN): The following child(ren) is/are under 18 and were born to or adopted by my spouse and me during our marriage or paternity has been established. NAME SOCIAL SECURITY NUMBER Currently Resides with: Mother DATE OF BIRTH Father Current Address: © Superior Court of Arizona in Maricopa County March 18, 2008 ALL RIGHTS RESERVED DRS31f Page 1 of 4 Use current form American LegalNet, Inc. www.FormsWorkflow.com Case No. NAME SOCIAL SECURITY NUMBER Currently Resides with: Mother DATE OF BIRTH Father Current Address: NAME SOCIAL SECURITY NUMBER Currently Resides with: Mother DATE OF BIRTH Father Current Address: NAME SOCIAL SECURITY NUMBER Currently Resides with: Mother DATE OF BIRTH Father Current Address: 5. ACCESS About how many days each week does the other parent see the children? About how much time each day 6. MEDICAL INSURANCE • • • 7. Who provides medical insurance for the children? Mother or Father How much does that parent pay each month for the children’s medical insurance? $ If you are not sure how much it costs to insure the children, state how much that parent Number of people pays and for how many people: $ DAY CARE • • • 8. days hours Do the child(ren) require day care? Yes No If the child(ren) require day care, who pays it? Mother or Father How much does it cost each month on average over the entire year? $ INFORMATION ABOUT SPOUSAL MAINTENANCE/SUPPORT A. B. 9. Does Mother regularly pay court-ordered spousal maintenance/support (alimony)? Yes No If so, how much each month? $ Does Father regularly pay court-ordered spousal maintenance/support? Yes No If so, how much each month? $ INFORMATION ABOUT INCOME A. What is Mother’s gross (total) monthly income (before deductions and taxes)? $ © Superior Court of Arizona in Maricopa County March 18, 2008 ALL RIGHTS RESERVED DRS31f Page 2 of 4 Use current form American LegalNet, Inc. www.FormsWorkflow.com Case No. B. 10. What is Father’s gross (total) monthly income (before deductions and taxes)? $ INFORMATION ABOUT OTHER CHILDREN. A. Yes No B. Does Father pay court-ordered child support for any other children? If so, how much each month? $ Yes No C. Does Mother support any other natural or adopted children who also live with Mother? Yes No If so, how many and what are their names, ages and dates of birth? D. 11. Does Mother pay court-ordered child support for any other children? If so, how much each month? $ Does Father support any other natural or adopted children who also live with Father? Yes No If so, how many and what are their names, ages and dates of birth? OTHER CHILD SUPPORT ORDERS Are there any other child support orders in effect for any of the children in described in #10 No above? Yes If so, list the name of the child affected, the name of the issuing court(s) and case number(s): 12. PREGNANCY Wife is not pregnant, or Wife is pregnant. The baby is due on (date), (and, check one box below) The Petitioner and Respondent are the parents of the child, or Petitioner is not the parent of the child, or Respondent is not the parent of the child 13. SUMMARY OF WHAT I SAY ABOUT OUR CHILDREN THAT IS DIFFERENT FROM WHAT MY SPOUSE ASKED FOR IN THE CHILD SUPPORT INFORMATION FORM: Address Information. It is very important for you (Petitioner and Respondent) to keep the court informed of your must current address. This means that if the address information on this form is incorrect or if you change address, you must contact the Clerk of the Court and give them your new or current address. Change of Address forms can be obtained at the Self-Service Center located at all courthouse locations: 101 West Jefferson, 1st Floor, Phoenix, 620 West Jackson, Phoenix,; 222 East Javelina, Mesa; Northwest Regional Center, 14264 West Tierra Buena Lane, Surprise; Northeast Regional Court Center, 18380 North 40th St., Phoenix; San Tan Regional Court Center, 201 East Chicago, Chandler; or on the Internet at: http://www.superiorcourt.maricopa.gov/SuperiorCourt/Self-ServiceCenter/forms/ © Superior Court of Arizona in Maricopa County March 18, 2008 ALL RIGHTS RESERVED DRS31f Page 3 of 4 Use current form American LegalNet, Inc. www.FormsWorkflow.com Case No. OATH AND VERIFICATION OF RESPONDENT STATE OF ARIZONA Maricopa County ) )ss. I, the Respondent, being duly sworn and under oath, state that I have read this Response. All the statements in the Response are true, correct and complete to the best of my knowledge and belief. SIGNED: Respondent’s Signature Subscribed and sworn before me this date: by Respondent’s Name NOTARY PUBLIC: My commission expires: © Superior Court of Arizona in Maricopa County March 18, 2008 ALL RIGHTS RESERVED DRS31f Page 4 of 4 Use current form American LegalNet, Inc. www.FormsWorkflow.com