For Clerk’s Use Only SUPERIOR COURT OF ARIZONA MOHAVE COUNTY ATLAS Number(s) (if applicable) _______________________________________ Case No._______________________________ ***NOTE*** For Use WITHOUT Minor Children FAMILY COURT COVER SHEET (Check only one): 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 Dissolution (Divorce) Legal Separation Annulment Order of Protection Other ___________________________ INSTRUCTIONS: • You must provide the following information about yourself and the other party. • Type or print neatly in black ink. • If more room is needed for Petitioner/Respondent, please attach a separate page. Information About the Petitioner: Information About the Respondent Name: Name: Address: Address: City, State, Zip: City, State, Zip: Home Phone #: Work Phone # Home Phone #: Work Phone # Cell Phone/Pager Date of Birth Cell Phone/Pager Date of Birth Social Security # E-Mail address: Social Security # E-Mail address: (***SEE NOTE***) (***SEE NOTE***) Lawyer’s Name and Bar Number: ________________________________________________________________ (Provide this information only if YOU have an Attorney) Do you need an Interpreter Yes No If yes, what language: ___________________________ 5/18/2010 Page 1 of 1 American LegalNet, Inc. www.FormsWorkFlow.com