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Affidavit Regarding Minor Children Form. This is a Arizona form and can be use in Mohave Local County.
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Tags: Affidavit Regarding Minor Children, Arizona Local County, Mohave
For Clerk’s Use Only
Name of Person Filing:
___________________________________
Mailing Address:
___________________________________
City, State, and Zip Code:
___________________________________
Daytime Phone Number:
___________________________________
Evening Phone Number:
___________________________________
ATLAS Number (if applicable):___________________________________
State Bar Number (if applicable):_________________________________
Self (Without Attorney) or
Representing:
Attorney for:
Petitioner
Respondent
SUPERIOR COURT OF ARIZONA
MOHAVE COUNTY
Case Number: ________________________
(Name of Petitioner)
AFFIDAVIT REGARDING
MINOR CHILDREN
AND
(Name of Respondent)
NOTICE: This “Affidavit Regarding Minor Children” is required for all custody cases.
You must fill
out this Affidavit completely, and provide accurate information. Use additional paper if necessary. You
must give copies of this Affidavit and all other required documents to the other party, and to the judge.
1.
CHILDREN OF THE PARTIES WHO ARE UNDER 18 YEARS OLD. The following
child(ren) are under age 18 and were born to, or adopted by, me and the other party.
Name
Birthdate:
Name
Birthdate:
2.
Age:
Age:
Name
Birthdate:
Name
Birthdate:
Age:
Age:
INFORMATION REGARDING WHERE THE CHILDREN UNDER 18 YEARS OLD
HAVE LIVED FOR THE LAST 5 YEARS.
Child’s Name:
Address:
City, State:
To
Child’s Name:
Address:
City, State:
Dates: From
Lived with:
Relationship to Child:
To
Child’s Name:
Address:
City, State:
3.
Dates: From
Lived with:
Relationship to Child:
Dates: From
Lived with:
Relationship to Child:
To
COURT CASES IN WHICH I HAVE BEEN A PARTY/WITNESS THAT INVOLVED
THE CUSTODY/PARENTING TIME OF THE CHILD(REN). (Check one box.)
I have or
have not been a party/witness in court in this state or in any other state that
involved the custody/parenting time of the child(ren) named above. (If so, explain on separate paper. If
not, go on.)
Revised: 11/8/2010
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Case No.__________________________
Name of each child:
Name of Court:
Court Case Number:
How the child is involved:
Summary of any Court Order:
4.
Court Location:
Current Status:
INFORMATION REGARDING PENDING COURT CASES RELATED TO THE
CUSTODY OF THE CHILD(REN). (Check one box.)
I do have or
I do not have information about a custody/parenting time court case relating to any
of the children named above that is pending in this state or in any other state. (If so, explain. If not, go
on.)
Name of each child:
Name of Court:
Court Case Number:
How the child is involved:
Summary of any Court Order:
5.
Court Location:
Current Status:
CUSTODY OR PARENTING TIME CLAIMS OF ANY PERSON. (Check one box.)
I do know or
I do not know a person other than the Petitioner or the Respondent who has
physical custody or who claims custody or parenting time rights to any of the children named in this
Affidavit.
(If so, explain below. If not, go on.)
Name of each child:
Name of person with the claim:
Address of person with the claim:
Nature of the claim:
OATH OR AFFIRMATION AND VERIFICATION
State of Arizona
Mohave County
)
) ss.
I swear or affirm that the information on this document is true and correct under penalty of perjury.
_________________________________________
SIGNATURE
______________________________
DATE
Sworn to or Affirmed before me this ______________ day of ______________________, 20_________
by _________________________________________
My Commission Expires: _______________________
Revised: 11/8/2010
____________________________________
Deputy Clerk or Notary Public
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