Name: Self Representing: Petitioner Respondent (If Attorney) State Bar Number: SUPERIOR COURT OF ARIZONA IN MARICOPA COUNTY FOR CLERK’S USE ONLY Case No. Petitioner ATLAS No. Respondent FAMILY COURT / SENSITIVE DATA COVERSHEET WITH CHILDREN (CONFIDENTIAL RECORD) Fill out. File with Clerk of Court. Social Security Numbers should appear on this form only and should be omitted from other court forms. Access Confidential pursuant to ARFLP 43(G)(1). Petitioner A. Personal Information: Name Gender Male or Female Respondent Male or Female Date of Birth (Month/Day/Year) Social Security Number WARNING: DO NOT INCLUDE MAILING ADDRESS ON THIS FORM IF REQUESTING ADDRESS PROTECTION Mailing Address City, State, Zip Code Contact Phone Email Address Current Employer Name Employer Address Employer City, State, Zip Code Employer Telephone Number Employer Fax Number B. Child(ren) Information: Child Name C. Gender Child Social Security Number Type of Case being filed - Check only one category. *Check only if no other category applies Dissolution (Divorce) Paternity Legal Separation *Custody/Visitation Annulment *Child Support Order of Protection Other © Superior Court of Arizona in Maricopa County July 15, 2010 ALL RIGHTS RESERVED Child Date of Birth Interpreter Needed: Yes No If yes, what language? DRSDS10f-C Page 1 of 1 Use most current version American LegalNet, Inc. www.FormsWorkFlow.com