FOR CLERK’S USE ONLY Name of Person Filing: _____________________________________________ Mailing Address: _____________________________________________ City, State, Zip Code: _____________________________________________ Day/Evening Phone Number: __________________________________________ SUPERIOR COURT OF ARIZONA MOHAVE COUNTY ________________________________________ (Name of Petitioner) Case Number: ________________________________ RESPONSE TO PETITION FOR LEGAL SEPARATION WITHOUT MINOR CHILDREN ________________________________________ (Name of Respondent) STATEMENTS TO THE COURT, UNDER OATH GENERAL INFORMATION: 1. ABOUT MY SPOUSE, THE PETITIONER: Name: ______________________________________________________________________________ Address: ______________________________________________________________________________ County of Residence: _________________________________________________________________________ Date of Birth: ______________________________________________________________________________ Occupation(s): ______________________________________________________________________________ Starting with today, number of months/years in a row my spouse has lived in Arizona: _______________________ 2. ABOUT ME, THE RESPONDENT Name: ______________________________________________________________________________ Address: ______________________________________________________________________________ County of Residence:__________________________________________________________________________ Date of Birth: ______________________________________________________________________________ Occupation(s): ______________________________________________________________________________ Starting with today, number of months/years in a row I have lived in Arizona:_______________________ 3. ABOUT OUR MARRIAGE Date of Marriage: _____________________________________________________________________________ City and state or county where we were married:_____________________________________________________ 4. ABOUT THE LEGAL SEPARATION (check one box) I want to be legally separated from my spouse, OR I do not want to be legally separated from my spouse because my marriage is over and I want to be divorced. INFORMATION ABOUT PROPERTY AND DEBTS Instructions: You must be specific. You must describe the property and debt that should go to you or be paid by you and then check the box. You must then describe the property and debt that should go to or be paid by your spouse, and check the box. For example, under household furnishing you could say, blue and white living room sofa, and then check the box to say whether it should go to you or to your spouse. Never list an item and check both the Petitioner and the Respondent box. Page 1 of 6 9/28/2010 American LegalNet, Inc. www.FormsWorkFlow.com Case No._____________________________________ 5a. COMMUNITY PROPERTY: (check one box) My Spouse and I did not acquire any community property during the marriage, OR My spouse and I acquired community property during our marriage, and we should divide it as follows: Description of property/ Value of property: My Spouse (Petitioner) Me (Respondent) Value Real estate at: _________________________ Legal Description: _________________________ ________________________________________ $______________ Real estate at: _________________________ Legal Description: _________________________ ________________________________________ $______________ Household furniture and appliances: ________________________________________ ________________________________________ ________________________________________ ________________________________________ $______________ $______________ $______________ $______________ Household furnishings: ________________________________________ ________________________________________ ________________________________________ ________________________________________ $______________ $______________ $______________ $______________ Other items: ________________________________________ ________________________________________ ________________________________________ ________________________________________ $______________ $______________ $______________ $______________ Pension/retirement fund/profit sharing/stock/401k: ________________________________________ ________________________________________ ________________________________________ ________________________________________ $______________ $______________ $______________ $______________ Motor vehicles: Make: ___________________________________ Model:___________________________________ VIN Number:______________________________ Lien Holder:_______________________________ Make: ___________________________________ Model:___________________________________ VIN Number:______________________________ Lien Holder:_______________________________ $______________ $______________ Page 2 of 6 9/28/2010 American LegalNet, Inc. www.FormsWorkFlow.com Case No.____________________________________ 5b. SEPARATE PROPERTY. (Check all boxes that apply.) I do not have any property that I brought into the marriage or separate property. My spouse, the Petitioner does not have any property that he or she brought into the marriage or separate property. I have property that I brought into the marriage or I have separate property. I want this property awarded to me as described below. Separate Property: (List the property and the value of the property, and check the box to tell the Court who should get the property.) Description of property/ Value of property: ____________________________________ My Spouse (Petitioner) Me (Respondent) Value $______________ ____________________________________ ____________________________________ $______________ ____________________________________ 6a. $______________ $______________ COMMUNITY DEBTS: (Check one box) My spouse and I did not incur any community debts during the marriage, OR We should divide the responsibility for the debts incurred during the marriage as follows: Description of debt/ Amount of debt: ____________________________________ My Spouse (Petitioner) Me (Respondent) Value $______________ ____________________________________ ____________________________________ $______________ ____________________________________ $______________ ____________________________________ $______________ ____________________________________ 6b. $______________ $______________ SEPARATE DEBTS. (Check all boxes that apply.) My spouse and I do not have any debts that were incurred prior to the marriage or separate debt, OR I have separate debt or debt that I incurred prior to the marriage that should be paid by me as described below: My spouse has separate debt or debt that he or she incurred prior to the marriage that should be paid by my spouse as described below: Description of debt/ Amount of debt: ____________________________________ My Spouse (Petitioner) Me (Respondent) Value $______________ ____________________________________ $______________ ____________________________________ $______________ ____________________________________ $______________ Page 3 of 6 9/28/2010 American LegalNet, Inc. www.FormsWorkFlow.com Case No.______________________________________ 7. TAX RETURNS: (Check this box if this is what you want) After the Judge or Commissioner signs the Decree of Legal Separation, we will pay federal and state taxes as follows: For previous years the parties will file joint federal and state income tax returns. In addition, for previous calendar years, both parties will pay and hold the other harmless from half of all additional income taxes, if any, and other costs, and each will share equally in any refunds. For this calendar year (the year that the Decree is signed) and all future calendar years, each party will, subject to IRS Rules and Regulations, file Joint Tax Returns or Separate Tax Returns. 8. SPOUSAL MAINTENANCE/SUPPORT (ALIMONY): (Check the box that applies to you) Neither party is entitled to Spousal Maintenance (alimony), OR Petitioner OR Respondent is entitled to Spousal Maintenance because: (Check one or more of the box(es) below that apply. At least one reason must apply to get spousal maintenance.) Person lacks sufficient property to provide for his or her reasonable needs: Person is unable to support himself or herself through appropriate employment: Person is the custodian of a child(ren) whose age or condition is such that the person should not be required to seek employment outside the home; Person lacks earning ability in the labor market adequate to support himself or herself; AND/OR, Person contributed to the educational opportunities of the other spouse or had a marriage of long duration and is now of an age that precludes the possibility of gaining employment adequate to support himself or herself. 9. PREGNANCY: Wife is not pregnant, OR Wife is pregnant The baby is due on _______________(date), (and, check one box below): The Petitioner and Respondent are the parents of the child, OR Petitioner is not the parent of the child, OR Respondent is not the parent of the child. WARNING. If wife is pregnant and the Petitioner and the respondent are the parents of the child, STOP. YOU MUST FILE THE PAPERS FOR LEGAL SEPARATION WITH MINOR CHILDREN. 10. SUMMARY OF WHAT I ASKED FOR THAT IS DIFFERENT FROM WHAT MY SPOUSE ASKED FOR IN THE PETITION: (Here summarize what is different between what you want and what your spouse asked for.) ____________________________________________________________________________________________ ____________________________________________________________________________________________ ____________________________________________________________________________________________ ____________________________________________________________________________________________ ____________________________________________________________________________________________ 11. CONCILIATION. True or False. (Check one box.) The conciliation requirements under Arizona law either do not apply or have been met. (This must be a true statement or you cannot file for Legal Separation.) 12. GENERAL DENIAL: I deny anything stated in the Petition that I have not specifically admitted, qualified, or denied. Page 4 of 6 9/28/2010 American LegalNet, Inc. www.FormsWorkFlow.com Case No._________________________________ REQUESTS TO THE COURT: A. Legally separate the parties or LEGALLY SEPARATE OR CHANGE TO DIVORCE: Change this case to a divorce case because my marriage is over and either I or my spouse have lived in Arizona for the last 90 days. B. SPOUSAL MAINTENANCE/SUPPORT (ALIMONY): Order spousal maintenance/support to be paid by Petitioner, or Respondent through the Clearinghouse in the amount of _________________ per month, and the statutory fee, beginning with the first day of the month after the Judge or Commissioner signs the Decree of Legal Separation and continuing until the person receiving the spousal maintenance is deceased, or for ______________ months. C. COMMUNITY PROPERTY: D. COMMUNITY DEBTS: Order each party to pay community debts as requested in this Response, and to pay any other community debts unknown to the other party. Order each party to pay and hold the other party harmless from debts incurred by him or her since the parties separation on (date): ____________________ E. SEPARATE PROPERTY AND DEBT: F. Make a fair division of all community property as requested in this Response. Award each party his or her separate property and debt. OTHER ORDERS I AM REQUESTING (Explain request here) (Use separate page if necessary). __________________________________________________________________________________ __________________________________________________________________________________ __________________________________________________________________________________ __________________________________________________________________________________ __________________________________________________________________________________ __________________________________________________________________________________ OATH OR AFFIRMATION AND VERIFICATION OF RESPONDENT TO PETITION FOR LEGAL SEPARATION STATE OF ARIZONA County of Mohave ) ) ss. ) The contents of this document are true and correct under penalty of perjury. _________________________________________ Signature Affirmed before me this: _____________________ (Date) ________________________ Date by __________________________________________ Printed Name of Person Who Signed Seal/My Commission Expires: __________________ ______________________________________ Deputy Clerk or Notary Public Page 5 of 6 9/28/2010 American LegalNet, Inc. www.FormsWorkFlow.com Case No._____________________________________ Copy of the foregoing mailed To my spouse on ________________________________ Month/Day/Year And at the following address: ________________________________________________ ________________________________________________ ________________________________________________ Page 6 of 6 9/28/2010 American LegalNet, Inc. www.FormsWorkFlow.com