MOHAVE COUNTY SUPERIOR COURT DOMESTIC RELATIONS COVER SHEET Please provide the following information. You must keep the Court advised of your current mailing address during the pendency of these proceedings. PETITIONER’S NAME and ADDRESS RESPONDENT’S NAME and ADDRESS _____________________________________________ Last First Middle _______________________________________________ Last First Middle _______________________________________________ Mailing Address _______________________________________________ Mailing Address _______________________________________________ City State Zip Code _______________________________________________ City State Zip Code _______________________________________________ Date of Birth SS# (***SEE NOTE***) _______________________________________________ Date of Birth SS# (***SEE NOTE***) (Date Format: dd/mm/yyyy) (Date Format: dd/mm/yyyy) _______________________________________________ Daytime Telephone Number PETITIONER’S ATTORNEY None ***NOTE*** _______________________________________________ Name State Bar No. _______________________________________________ Mailing Address _______________________________________________ City State Zip Code SOCIAL SECURITY NUMBER MUST BE PROVIDED. IT CAN BE OMITTED FROM THIS DOCUMENT AS LONG AS YOU INCLUDE IT ON THE CONFIDENTIAL SENSITIVE DATA FORM (ATTACHED). __________________________________________ Telephone Number IS DOMESTIC VIOLENCE AN ISSUE IN THIS CASE: YES NO TYPE OF ACTION Dissolution With Children Without Children Legal Separation With Children Without Children Annulment With Children Without Children Paternity/Maternity Custody/Visitation Establish Support Domesticated Decree Foreign Judgment Reciprocal Support Other:_____________________________________________________________________ NOTICE: In order for proper identification, it is necessary that the above requested information be provided at the time of filing your petition/complaint. 6/5/2008 American LegalNet, Inc. www.FormsWorkflow.com