For Clerk’s Use Only Name of Person Filing: ________________________________________ Mailing Address: ________________________________________ City, State, Zip Code: ________________________________________ Daytime Phone Number: ________________________________________ Evening Phone Number: ________________________________________ ATLAS Number (if applicable): ________________________________________ State Bar Number (if applicable):______________________________________ Representing: Self Petitioner Respondent SUPERIOR COURT OF ARIZONA MOHAVE COUNTY ___________________________________ Petitioner Case Number ___________________________ EXPEDITED PROCESS REQUEST TO ENFORCE: AND Child Support Child Support Arrears Spousal Maintenance Spousal Maintenance Arrears Medical Insurance Coverage Uninsured Medical/Dental/Vision Expenses Parenting Time ___________________________________ Respondent SECTION A: COMPLETE ONLY IF YOU HAVE MARKED ONE OR MORE BOXES ABOVE WHICH REFER TO ENFORCEMENT OF SUPPORT , the Honorable ________________________________, a Judicial Officer of the On this date Superior Court of Arizona, ordered _________________________________________to pay child support, spousal maintenance, uninsured medical /dental /vision expenses, and / or to obtain medical insurance coverage as follows: ______________________________________________________________________________________ ______________________________________________________________________________________. The total amount of child support or spousal maintenance past due is $ _______________, for the time period beginning ________________, through ________________. The total amount of medical, dental or vision care expense reimbursement that is past due is ___________________. Documentation of these expenses has been presented to the other party and reimbursement is more than 30 days past due. I request that the Court consider any or all of the following action(s): • Order the other party to bring to the conference those items set forth in the Order to Appear. • Enter judgment for past-due support, unreimbursed uninsured medical/dental/vision care expenses, clerk’s fees, service costs, other court costs against the other party. 8/14/2006 Page 1 of 3 American LegalNet, Inc. www.FormsWorkflow.com Case No.______________________ • Enter an “Order of Assignment” for payments on current child support, child support arrears, current spousal maintenance, and/or spousal maintenance arrears against the other party. • Order the other party to pay support through the Support Payment Clearinghouse. • Find the other party in civil contempt of court and order sanctions which may include, but are not limited to, incarceration and the posting of a surety bond. • Issue a child support arrest warrant if the other party fails to appear and/or enter a default judgment. • Order the other party to provide evidence of medical insurance coverage within a fixed period of time. • Order reimbursement of uninsured medical / dental / vision expenses. • Order other relief as deemed just and proper by the court. SECTION B: COMPLETE ONLY IF YOU HAVE MARKED THE BOX FOR ENFORCEMENT OF PARENTING TIME On this date _______________, the Honorable ____________________________________ a Judicial Officer of the Superior Court of Arizona, signed an Order establishing the following schedule for parenting time: ______________________________________________________________________________________ ______________________________________________________________________________________ ______________________________________________________________________________________ The other party, _______________________________, failed to comply with the parenting time order in the following manner: ______________________________________________________________________________________ ______________________________________________________________________________________ ______________________________________________________________________________________ I request that the court consider any or all of the following action(s • Compel compliance with the parenting time order. • Find the other party in civil contempt of court and order sanctions, which may include, but are not limited to, incarceration. • Order either or both parties to mediation, counseling, or supervised parenting time pursuant to A.R.S. §25-410. • Issue a civil arrest warrant or enter an order for the requested relief should the other party fail to appear at the conference. • Enter an order for other relief as deemed just and proper by the court. 8/14/2006 Page 2 of 3 American LegalNet, Inc. www.FormsWorkflow.com Case No.______________________ EXPEDITED PROCESS REQUEST TO ENFORCE OATH AND VERIFICATION I have read the foregoing document and the facts therein are true and correct to the best of my knowledge. . Signature of party filing STATE OF ARIZONA ) COUNTY OF MOHAVE )ss. Subscribed and sworn or affirmed and acknowledged before me this date: by . . My commission expires: . Notary Public or Deputy Clerk IMPORTANT INFORMATION FOR PETITIONER AND RESPONDENT IT IS THE RESPONSIBILITY OF THE PETITIONER AND RESPONDENT TO KEEP THE COURT ADVISED OF THEIR CORRECT AND CURRENT ADDRESS. 8/14/2006 Page 3 of 3 American LegalNet, Inc. www.FormsWorkflow.com