For Clerk’s Use Only Name of Person Filing: _________________________________ Mailing Address: _________________________________ City, State, Zip Code: _________________________________ Daytime Phone Number: _________________________________ Evening Phone Number: _________________________________ ATLAS Number (if applicable): _________________________________ Attorney Bar Number (if applicable): _________________________________ Self Representing Petitioner OR Respondent SUPERIOR COURT OF ARIZONA MOHAVE COUNTY Case Number:_________________________ Name of Petitioner PETITION FOR EMERGENCY TEMPORARY ORDER AND For Child Custody To Stop or Change Parenting Time (formerly known as “Visitation”) Other WITHOUT NOTICE, or WITH NOTICE __________________________________ Name of Respondent I, MAKE THE FOLLOWING STATEMENTS TO THE COURT (Name of Person Asking for Emergency Order) UNDER OATH pursuant to Rule 65(d) A.R.Civ.P. 1. REASONS WHY I NEED THIS ORDER. Explain in detail the emergency facts which now exist, what injury you fear could occur, why you need this Order immediately, and why an emergency order is the only way to solve the problem: (Use additional paper if necessary): ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ 2. NOTICE TO THE OTHER PARTY. Answer one of the following about notice to the other party: This is how I gave notice to the other party or his or her attorney: Whom I gave notice to: When I gave notice: How I gave notice: This is how I tried to give notice to the other party or his or her attorney: Who I tried to give notice to: When: How: Revised: 10/28/2010 Page 1 of 4 American LegalNet, Inc. www.FormsWorkFlow.com Case No.______________________________ I did not try to give advanced notice: (Explain what injury, loss or damage you would suffer if you gave the other party advance notice of this Petition.) _____________________________________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________ 3. PEOPLE INVOLVED. This Petition concerns the following people: Name of Mother: Name of Father: Names of Other People: ________________________________________________ ________________________________________________ ________________________________________________ ________________________________________________ ________________________________________________ ________________________________________________ Name of minor child(ren) and their ages: ________________________________________________ ________________________________________________ ________________________________________________ ________________________________________________ ________________________________________________ 4. PETITION FOR TEMPORARY ORDERS: I filed a “Petition for Temporary Orders” 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 Petition. (You cannot file this emergency petition unless you filed or are filing a “Petition for Temporary Orders.”) 5. DIVORCE OR OTHER PETITION: You cannot file this emergency petition 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 custody/Parenting Time” (first court order for paternity and/or support has been established) “Petition for Parenting time” (first court order for paternity and/or support has been established) B. 6. Date Petition was filed ___________________. INFORMATION ABOUT OTHER EMERGENCY CASES INVOLVING THE PARTIES OR THE CHILD(REN): Check the boxes that apply and then write in the information requested. Current emergency cases: To the best of my knowledge, there are no pending proceedings for emergency orders about the minor child(ren) in any other court. (If this is not a true statement, see a lawyer for help.) Past emergency cases: Either or both parties have filed for emergency court orders in the past. (If so, you most complete the following information. Use additional paper if necessary): Revised: 10/28/2010 Page 2 of 4 American LegalNet, Inc. www.FormsWorkFlow.com Case No.___________________________ Name of Parties: __________________________________________________________________ Date of order, judgment, dismissal, etc.: ________________________________________________ Explain what order or judgment said, or basis for dismissal: ________________________________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ Court Case Number: ___________________; Location of court (city and state):_________________ ________________________________________________________________________________ 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) Name of Parties: __________________________________________________________________ Court Case Number: ___________________; Location of court (city and state):_________________ ________________________________________________________________________________ What order or judgment said:_________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ Explain type of case: (Criminal, Order of Protection, Injunction against Harassment, divorce, Paternity, etc.)_____________________________________________________________________________ Status of case now: Final Order entered; Case is over. Date Order/Judgment signed: ______________________ Hearing date set: _____________________(date) _________________________(time) Location/address: ____________________________________________________________ Other (explain in detail): _______________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ 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 Service, involving the parties or the minor child(ren). If so, explain the agency, date, type of case, and status of case right now: _________________________________________________________________________________ _________________________________________________________________________________ _________________________________________________________________________________ _________________________________________________________________________________ Revised: 10/28/2010 Page 3 of 4 American LegalNet, Inc. www.FormsWorkFlow.com Case No.____________________________ 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: _________________________________________________________________________________ _________________________________________________________________________________ _________________________________________________________________________________ _________________________________________________________________________________ I MAKE THE FOLLOWING REQUESTS TO THE COURT: 1. FOR A TEMPORARY EMERGENCY ORDER as follows: (Check the boxes that apply): Awarding me Temporary Emergency Custody of the minor child(ren) until a full court hearing. Entering a “Temporary Emergency Order” about Parenting Time Rights. Other (explain): _____________________________________________________________ __________________________________________________________________________ __________________________________________________________________________ 2. FOR A COURT HEARING when the parties can testify about the facts related to this “Petition for a Temporary Emergency Order” and the “Petition 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, being duly sworn and under oath, state that I have read this Petition and all the statements in the Petition are accurate and complete to the best of my knowledge and belief. I am not filing this Petition to harass or to cause unnecessary delay or to increase the cost of litigation. I understand that if the judge finds that I did file this Petition for an improper purpose, the judge may order contempt or another sanction against me, including assessing me for any and all reasonable costs, attorney fees, or other expenses caused because of filing this Petition. Signed:_______________________________________ Date:______________________________ SUBSCRIBED AND SWORN to before me this __________ day of __________, 20____ by ___________________________________________ My commission Expires: __________________________ ___________________________________ Deputy Clerk / Notary Public Revised: 10/28/2010 Page 4 of 4 American LegalNet, Inc. www.FormsWorkFlow.com