FOR CLERK'S USE ONLY Name of Person Filing: _________________________________ Mailing Address: _________________________________ City, State, Zip Code: _________________________________ Phone Number(s): _________________________________ ATLAS Number (if applicable): _________________________________ Attorney Bar Number (if applicable): ________________________________ Representing: Self (Without a Lawyer) OR Attorney for: Petitioner Respondent SUPERIOR COURT OF ARIZONA MOHAVE COUNTY Case Number ___________________________ ____________________________________ Name of Petitioner MOTION FOR TEMPORARY ORDERS Check all that apply: For legal decision making For parenting time ("visitation") For child support Other: ____________________________________ Name of Respondent REQUIRED INFORMATION FROM FILING PARTY, UNDER OATH: 1. 2. MY RELATIONSHIP TO THE CHILD(REN) IS: Mother or Father INFORMATION ABOUT THE PETITION FOR LEGAL DECISION MAKING, PARENTING TIME and/or SUPPORT. (You cannot file a "Motion for Temporary Orders" unless you or the other party have filed, or will file at the same time you file this paperwork, all the paperwork for a "Petition for Legal Decision Making, Parenting Time and/or Support.") A. B. C. Date "Petition for Legal Decision Making, Parenting Time and/or Support" was filed:__________________ Name of court where Petition was filed: _____________________________________________ Information about court hearing scheduled for that Petition (if hearing is scheduled): 1) DATE and TIME OF HEARING: ________________________________________________ 2) NAME OF JUDICIAL OFFICER TO HEAR CASE: __________________________________ 3) LOCATION OF HEARING: ____________________________________________________ 3. INFORMATION ABOUT OTHER TEMPORARY ORDERS. To the best of my knowledge, no temporary orders regarding these matters have been entered in any other Court, and no Court proceedings are pending for Temporary Orders. Check this box if this statement is true. If it is not true, do not check the box, do not file this paperwork and see a lawyer for help. 4. INFORMATION ABOUT OUR CHILD(REN): Name: Birth date: Current Address: County of residence: Father: Mother: Name: Birth date: Current Address: County of residence: Father: Mother: Revised: 1/1/2013 Page 1 of 3 American LegalNet, Inc. www.FormsWorkFlow.com Case No. _________________________ Name: Birth date: Current Address: County of residence: Father: Mother: Name: Birth date: Current Address: County of residence: Father: Mother: THIS IS WHAT I WANT THE COURT TO ORDER: 5. Check the box in front of each item that you want. If you do not want the Court to enter an Order for that item, do not check the box. MEDICAL INSURANCE AND/OR COSTS: An Order requiring the other party to provide medical and dental insurance for our child(ren) at no cost to me, OR to pay all the medical and dental expenses reasonably incurred by our minor child(ren). 6. 7. LEGAL DECISION MAKING (for parents only): The temporary care, legal decision making and control of the minor child(ren) to be awarded to _____________________________. PARENTING TIME: Temporary parenting time with the child(ren) as follows (be specific): TRANSPORTATION. Mother or pick-up the child(ren). Mother or return the child(ren). WEEKENDS (explain specifically) Father or Father or _________________________________ _________________________________ shall shall SUMMER MONTHS (explain specifically) HOLIDAYS AND BIRTHDAYS (explain specifically) TELEPHONE CALLS (explain specifically) OTHER (explain specifically) 8. CHILD SUPPORT: An Order requiring Mother or Father to pay a reasonable sum for child support as determined by the current guidelines for child support, and according to the Parent Worksheet for Child Support that I am submitting with this Petition. 9. BASIS FOR REQUEST: This request is based on the best interests of the minor child(ren) for the following reasons: Revised: 1/1/2013 Page 2 of 3 American LegalNet, Inc. www.FormsWorkFlow.com Case No. ______________________________ 10. OTHER REASONS AND/OR OTHER REQUESTS: (Please explain here in detail what else if anything you want the judge to order on a temporary basis and why you need the Order) REQUESTS TO THE COURT, UNDER OATH: 1. 2. To enter a Temporary Order granting what I requested. For any other Orders of the Court that are just. OATH OR AFFIRMATION STATE OF ARIZONA County of Mohave ) ) ss. ) I declare under penalty of perjury that the contents of this document are true and correct to the best of my knowledge and belief. SIGNATURE: Sworn to or affirmed before me this by day of . DATE:______________________________ , ______________ My Commission Expires:_________________ Notary Public / Deputy Clerk Revised: 1/1/2013 Page 3 of 3 American LegalNet, Inc. www.FormsWorkFlow.com