For Clerk’s Use Only Person Filing: ________________________________________________________ Address: ________________________________________________________ City, State, Zip Code: ___________________________________________________ Daytime/Evening Telephone: ________________________/_____________________ ATLAS Number (if applicable): ___________________________________________ Attorney Bar Number (if applicable): ________________________________________ Representing Self Petitioner Respondent SUPERIOR COURT OF ARIZONA MOHAVE COUNTY ____________________________________ (Name of Petitioner) Case Number:_____________________ MOTION FOR PRE-DECREE TEMPORARY ORDER WITHOUT NOTICE FOR CHILD CUSTODY ____________________________________ (Name of Respondent I MAKE THE FOLLOWING STATEMENTS TO THE COURT UNDER OATH OR AFFIRMATION: 1. MY NAME IS: ____________________________________________________________. (Name of Person asking for Emergency Order) 2. REASONS WHY I NEED THIS ORDER. Explain in detail the emergency facts which now exist, and what irreparable injury (serious or life-threatening injury or damage that cannot be prevented or undone) to you or the child(ren) that might occur without this Order (Use additional paper if necessary). ___________________________________________________________________________________ ___________________________________________________________________________________ ___________________________________________________________________________________ ___________________________________________________________________________________ Check here if continued on attached page(s). 3. PEOPLE INVOLVED. This Motion concerns the following people: Name of Mother: _______________________________________________________________ Name of Father: _______________________________________________________________ Name of Other Person: _______________________________________________________________ Name of Other Person: _______________________________________________________________ Name(s) of Children: _______________________________________________________________ _______________________________________________________________ _______________________________________________________________ _______________________________________________________________ 12/11/07 Page 1 of 4 American LegalNet, Inc. www.FormsWorkFlow.com Case No.______________________________ 4. REQUIRED INFORMATION: NOTICE OR REASONS WHY NOTICE NOT ATTEMPTED. Actual Notice regarding a request that affects another party’s rights concerning his or her children is normally required. Check the box to indicate whether you gave or attempted to give notice to any other parties or their attorneys. I ATTEMPTED TO GIVE NOTICE TO THE OTHER PARTY AS FOLLOWS: Explain when, how, and to whom you attempted to give notice. ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ OR, I DID NOT ATTEMPT TO GIVE NOTICE BECAUSE: If you checked this box you MUST explain what injury, loss or damage you or the child(ren) would suffer if you gave the other party advance notice of this Motion. (Use additional paper if necessary). ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ Check here if continued on attached pages(s) 5. MOTION FOR TEMPORARY ORDERS WITH NOTICE: I filed a “Motion for Temporary Orders with Notice” on (date)_______________________in the Superior Court of Arizona in Mohave County. I have attached a copy of it to the Judge’s/Commissioner’s copy and the other party’s copy of this Motion. (You cannot file this “Motion for Temporary Orders Without Notice” unless you filed or are filing a “Motion for Temporary Orders with Notice.”) 6. DIVORCE OR OTHER PETITION: You cannot file this “Motion for Temporary Orders Without Notice” unless you or the other party has already filed or you are filing one of the following petitions: A. I or the other party filed in the Superior Court in Mohave County a (check one box) “Petition for Divorce, or Legal Separation, or Annulment” “Petition for Paternity, and Custody” “Petition for Custody/Parenting Time” (where paternity and/or support already established) B. 7. 12/11/07 Date Petition was filed:______________________________. INFORMATION ABOUT OTHER EMERGENCY CASES INVOLVING THE SAME PARTIES OR CHILDREN: Check the boxes that apply and write in the information requested. Current emergency cases: To the best of my knowledge, there are no pending proceedings or Emergency Orders about these children in any other Court. (If this is not a true statement, this Court may not be able to enter an Order and you may want to consult a lawyer for advice.) Page 2 of 4 American LegalNet, Inc. www.FormsWorkFlow.com Case No.______________________________ Past emergency cases: Either or both parties have filed for Emergency Court Orders in the past. (If so, complete the following information. Use additional paper if necessary.) Names of Parties: ______________________________ _______________________________ ______________________________ _______________________________ Date of Order, Judgment, Dismissal, etc:_____________ Case No. _______________________ Location of Court (city and state): ____________________________________________________ Explain type of case. (Juvenile, Criminal, Order of Protection, etc.)__________________________ _______________________________________________________________________________ Explain what Order or Judgment said, or basis for dismissal:_______________________________ _______________________________________________________________________________ _______________________________________________________________________________ 8. ALL OTHER COURT CASES INVOLVING EITHER OR BOTH OF THE PARTIES: Describe all other Court cases that involve either or both of the parties, whether pending or not, including criminal cases. Complete all the information for each Court Order (use extra paper if necessary). Names of Parties: ______________________________ _______________________________ ______________________________ _______________________________ Date of Order, Judgment, Dismissal, etc:_____________ Case No. _______________________ Location of Court (city and state): ____________________________________________________ Explain type of case. (Juvenile, Criminal, Order of Protection, etc.)__________________________ _______________________________________________________________________________ Explain what Order or Judgment said, or basis for dismissal:_______________________________ _______________________________________________________________________________ _______________________________________________________________________________ Status of Case Now: Final Order Entered; Case is over. Date Order/Judgment signed:_____________________ Hearing Date Set On (date):____________________ at (time):_______________________ Location/address:___________________________________________________________ Other (explain in detail): ______________________________________________________ _______________________________________________________________________________ _______________________________________________________________________________ 9. 12/11/07 ANY OTHER GOVERNMENT AGENCY INVOLVEMENT WITH EITHER OR BOTH THESE PARTIES, OR THISE CHILDREN: State whether there have been or are any complaints with or investigations by any government agency, including Child Protective Services, involving the parties or the child(ren). If so, explain the agency, date, type of case, and status of case. Page 3 of 4 American LegalNet, Inc. www.FormsWorkFlow.com Case No.______________________________ ___________________________________________________________________________________ ___________________________________________________________________________________ ___________________________________________________________________________________ 10. CRIMES OF ANY PARTY: Explain here if any party involved with this case has been charged with committing a dangerous crime including child molestation or domestic violence: ___________________________________________________________________________________ ___________________________________________________________________________________ ___________________________________________________________________________________ I MAKE THE FOLLOWING REQUESTS TO THE COURT: 1. For a “Temporary Order Without Notice” as follows: Check the boxes that apply: Awarding me temporary custody of the child(ren) until a full Court Hearing. Other (explain): _______________________________________________________________ ___________________________________________________________________________________ ___________________________________________________________________________________ 2. For a Court Hearing when the parties can testify about the facts related to this “Motion for a Temporary Order Without Notice” and the “Motion for Temporary Orders,” so that the judge can decide whether to continue or modify the terms of the Emergency Order. 3. For any other Order that is in the best interests of the minor children named above. OATH OR AFFIRMATION AND VERIFICATION STATE OF ARIZONA County of Mohave ) ) ss. ) I swear or affirm that the information on this document is true and correct under penalty of perjury. ____________________________________________ ____________________________________ Sworn to or Affirmed before me this ______________ day of ___________, 20______ by _____________________________________ My Commission Expires:____________________ 12/11/07 _____________________________________ Notary Public / Deputy Clerk Page 4 of 4 American LegalNet, Inc. www.FormsWorkFlow.com