FOR CLERK'S USE ONLY Name of Person Filing: _____________________________________________ Mailing Address: _____________________________________________ City, State, Zip Code: _____________________________________________ Day/Evening Phone Number: __________________________________________ 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 Regarding the Matter of: ________________________________________ (Name of Petitioner) AND ________________________________________ (Name of Respondent) Case Number:__________________________ PETITION FOR LEGAL SEPARATION WITH MINOR CHILDREN GENERAL INFORMATION: 1. INFORMATION ABOUT ME, THE PETITIONER: Name: _____________________________________________________________________________ Address: _____________________________________________________________________________ Date of Birth: _____________________________________________________________________________ Occupation: _____________________________________________________________________________ I have lived in Arizona for __________ years and/or __________ months in a row. 2. INFORMATION ABOUT MY SPOUSE, THE RESPONDENT: Name: _____________________________________________________________________________ Address: _____________________________________________________________________________ Date of Birth: _____________________________________________________________________________ Occupation: _____________________________________________________________________________ He/she has lived in Arizona for __________ years and/or __________ months in a row. 3. INFORMATION ABOUT MY MARRIAGE: Date of Marriage;_____________________________ City and state, or country where we were married:__________________________________________________ 4. CHILDREN OF THE PARTIES WHO ARE LESS THAN 18 YEARS OLD (check one box): There are no children under the age of 18 either born to, or adopted by, the parties. NOTE: IF YOU CHECKED THIS BOX, STOP. YOU SHOULD BE USING THE PETITION PACKET TO GET A LEGAL SEPARATION WITHOUT CHILDREN. The following minor child(ren) are under age 18 and were born to or adopted by my spouse and me: (Attach extra pages if necessary). Child's Name: _______________________________________________________________________ Birth date: Address: _______________________________________________________________________ _______________________________________________________________________ Length of Time at Address: ______________________________________________________________ American LegalNet, Inc. www.FormsWorkFlow.com Case No.____________________________________ Child's Name: _______________________________________________________________________ Birthdate: Address: _______________________________________________________________________ _______________________________________________________________________ Length of Time at Address: ______________________________________________________________ Child's Name: _______________________________________________________________________ Birthdate: Address: _______________________________________________________________________ _______________________________________________________________________ Length of Time at Address: ______________________________________________________________ Child's Name: _______________________________________________________________________ Birthdate: Address: _______________________________________________________________________ _______________________________________________________________________ Length of Time at Address: ______________________________________________________________ 5. RESIDENCY REQUIREMENT: When I file this document with the court, either I OR my spouse live, or are stationed while a member of the Armed Forces, in Arizona. (WARNING: If this statement is not true, you cannot file for legal separation until it becomes true.) 6. DESIRE TO LIVE SEPARATE AND APART: My marriage is irretrievably broken (my marriage is over) or I and/or my spouse desire to live separate and apart. (This must be a true statement or you cannot file for a Petition for Legal Separation.) 7. DOMESTIC VIOLENCE: (If you intend to ask for joint legal decision making, there must have been no "significant" domestic violence in your marriage. A.R.S. �25-403.03.) Check the box that makes a true statement: Significant domestic violence 8. PREGNANCY: Petitioner/Respondent is not pregnant, OR Petitioner is pregnant Respondent 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 has OR has not occurred during this marriage. Page 2 of 8 Revised: 7/22/2015 American LegalNet, Inc. www.FormsWorkFlow.com Case No.____________________________________ 9. SPOUSAL MAINTENANCE/SUPPORT (ALIMONY): Neither party is entitled to Spousal Maintenance/Support (alimony); OR Petitioner OR Respondent is entitled to Spousal Maintenance/Support because: (Check one or more of the box(es) below that apply. At least one reason must apply to get spousal maintenance/support.) 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 minor 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. INFORMATION ABOUT PROPERTY AND DEBTS 10. (a) PROPERTY ACQUIRED DURING THE MARRIAGE: (Check one box.) My spouse and I did not acquire community property during the marriage; OR My spouse and I acquired community property during our marriage, and we should divide it as follows: (List the property and the value of the property, and check the box to tell the court who should get the property.) WARNING: You must be specific. You must describe the property that should go to you and then check the box