Person Filing: ________________________________________________________ Address: ________________________________________________________ City, State, Zip Code: ___________________________________________________ Daytime/Evening Telephone: ________________________/_____________________ ATLAS Number (if applicable): ___________________________________________ Attorney Bar Number (if applicable): ________________________________________ Self Representing Petitioner Respondent For Clerk’s Use Only SUPERIOR COURT OF ARIZONA MOHAVE COUNTY ____________________________________ (Name of Petitioner) Case Number:_____________________ MOTION FOR POST-DECREE TEMPORARY ORDER WITHOUT NOTICE FOR MODIFICATION OF ____________________________________ (Name of Respondent CHILD CUSTODY PARENTING TIME Other: _______________________ 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: ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ 12/13/07 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 page(s). 5. I FILED OR I AM GOING TO FILE A regular “Petition for Modification of Custody and/or Parenting Time” in the Superior Court of Arizona in Mohave County, I have attached a copy of that petition to the Judge’s copy and to the other party’s copy of this Motion. That request was filed or is going to be filed on this month/day/year: _______________________________ 6. 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 for 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.) 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.) _____________________________ ___________________________________________________________________________________ 12/13/07 Page 2 of 4 American LegalNet, Inc. www.FormsWorkFlow.com Case No.______________________________ Explain what Order or Judgment said, or basis for dismissal:___________________________________ ___________________________________________________________________________________ ___________________________________________________________________________________ 7. 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): _________________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________ _____________________________________________________________________ Check here if continued on attached page(s). 8. ANY OTHER GOVERNMENT AGENCY INVOLVEMENT WITH EITHER OR BOTH THESE PARTIES, OR THESE 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. _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ 9. CRIMES OF EITHER PARTY: Explain here if either parent or people involved with this Petition have been charged with committing a dangerous crime including child molestation or domestic violence: _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ 12/13/07 Page 3 of 4 American LegalNet, Inc. www.FormsWorkFlow.com Case No.______________________________ I MAKE THE FOLLOWING REQUESTS TO THE COURT: 1. For a “Temporary Modification Order Without Notice” as follows: Check the boxes that apply: Awarding me temporary custody of the child(ren) until a full Court hearing. Canceling parenting time (formerly “visitation”) for the other party until a full Court hearing. Changing the parenting time schedule until a full Court hearing, as follows: _________________________________________________________________________________ _________________________________________________________________________________ Other (explain): ________________________________________________________________ _________________________________________________________________________________ _________________________________________________________________________________ 2. For a Court hearing when the parties can testify about the facts related to this “Motion for a Temporary Modification Order Without Notice” and the “Petition for Modification of Custody and/or Parenting Time,” so that the judge can decide whether to continue or modify the terms of any emergency (without notice) Order. 3. For any other Order that is in the best interests of the minor children named above. OATH OR AFFIRMATION AND VERIFICATION I swear or affirm that the information on this document is true and correct under penalty of perjury. ____________________________________________________ Signature ________________________________ Date Sworn to or Affirmed before me this: __________ day of _________________, 20________ by ______________________________________________ My Commission Expires: ____________________________ 12/13/07 ____________________________________ Deputy Clerk or Notary Public Page 4 of 4 American LegalNet, Inc. www.FormsWorkFlow.com