FOR CLERK’S USE ONLY JK;LJK;LJL; JL;JLK;JLK 9789©789 )798( ;LJK;LJK;LJK;LJLK; JKL;JK;LJK;L JKLJLKJKL Name of Person Filing: _____________________________________________ Mailing Address: _____________________________________________ City, State, Zip Code: _____________________________________________ Day/Evening Phone Number: __________________________________________ ATLAS Number (if applicable) __________________________________________ Attorney Bar Number (if Applicable) _____________________________________ Self, Without a Lawyer OR Representing: Attorney for: Petitioner  Respondent 9780978 )907( SUPERIOR COURT OF ARIZONA MOHAVE COUNTY LJKL;JKL; Regarding the Matter of: Case Number:__________________________ ;LJK;LJKLJLK; PETITION FOR LEGAL SEPARATION WITHOUT MINOR CHILDREN ________________________________________ (Name of Petitioner) AND JLK ________________________________________ (Name of Respondent) GENERAL INFORMATION: 1. INFORMATION ABOUT ME, THE PETITIONER: 08 0LJ K;LJK;LJK;LJJKLK 90/20/20 JK;LJKL;JKL;JKL;JKL;J ;LJK;LJKLJLK; Name: _____________________________________________________________________________ Address: _____________________________________________________________________________ Date of Birth: _____________________________________________________________________________ Occupation: _____________________________________________________________________________ I have lived in Arizona for __________ years and/or __________ months in a row. 098 90 2. INFORMATION ABOUT, MY SPOUSE, THE RESPONDENT: L;L;JKL; J;LJKLJLK 90/40/40 K;LJK;LJK;LJL;JLK JLK Name: _____________________________________________________________________________ Address: _____________________________________________________________________________ Date of Birth: _____________________________________________________________________________ Occupation: _____________________________________________________________________________ I have lived in Arizona for __________ years and/or __________ months in a row. JKL;JKL;JK 3. INFORMATION ABOUT MY MARRIAGE: 90 /10 /10 Date of Marriage;_____________________________ City and state, or country where we were married:__________________________________________________ JK;LJK;LJKL;J;JK 4. 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.) 5. 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.) 6/18/2010 Page 1 of 5 American LegalNet, Inc. www.FormsWorkFlow.com LJKL;JKL; Case No.___________________________________ 6. PREGNANCY: Wife is not pregnant 7. 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 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 8. (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, and describe the property that should go to your spouse, and check the box. For example, under household furnishing you could say, blue and white living room sofa, and then check the box to say whether it should go to you or to your spouse. never list an item and then check both the Petitioner box and the Respondent box. You (Petitioner) Your Spouse (Respondent) Value 32 00.4 DESCRIPTION OF PROPERTY/ VALUE OF PROPERTY:  Real estate at: _______________________ Legal Description: ____________________ ___________________________________  $_______________  Real estate at: _______________________ Legal Description: ____________________ ___________________________________ FSDG FDG G G G FD FD  $_______________ $_______________ $_______________ $_______________ $_______________ $_______________ 00.423 00.6 4 00.254,3 00.43 00.43 G G FDS FDS FD G G G FD FD FD G G G FSDG FDS FDS FSD G G F F G D G DS FD FD 6/18/2010 32 00.4 DFG FDSG FSDG FSD G SFDG GS G F FF Household furniture and appliances: ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ Page 2 of 5 American LegalNet, Inc. www.FormsWorkFlow.com LJKL;JKL; Case No.___________________________________ DESCRIPTION OF PROPERTY/ VALUE OF PROPERTY: (Continued) You (Petitioner) Your Spouse (Respondent) Value Household furnishings: ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ FDSG FSDG F DSG F DSG FDSG FDSG FDSG F DSG FDSG FDS G DSG FD $_______________ $_______________ $_______________ $_______________ $_______________ $_______________ Other items: ___________________________________ ___________________________________ ___________________________________ ___________________________________ GF DSG FDSG FDS G FDSG FSDG F DG FDSG FSD G FDSG $_______________ $_______________ $_______________ $_______________ Pension/retirement fund/profit sharing/stock plan/401K: ___________________________________ ___________________________________ ___________________________________ $_______________ $_______________ $_______________ 00.6 54,5 00.6 54 00.6 00.3 00.543 00.532 00.6 4 00.5 00.32 00.43  G FDSG FDSG F DSG FDSG F DSG FDS 00.3 00.7 00.5 Motor Vehicles: Make _____________________________ Model _____________________________ Year__________ Vin _____________________________ Lien Holder __________________________ 00.435,43 $_______________ G FSDG FSDG FDSG FDSG G FDSG FDSG FDS FDSG FDG FDSG FDG FDSG FD 546 4 00.543 G FDSG FDSG FDSG FDSG FDS G SFDG FDSG FDG FSD Make _____________________________ Model _____________________________ Year__________ Vin _____________________________ Lien Holder __________________________ 436 4 8. (b) $_______________ PROPERTY ACQUIRED BEFORE THE MARRIAGE: (Check all boxes that apply.) I do not have any property that I brought into the marriage (separate property). My spouse, the Respondent does not have any property that he or she brought into the marriage (separate property). I have property that I brought into the marriage (separate property). I want this property awarded to me as described below. My spouse, the Respondent, has property that he or she brought into the marriage. I want this property awarded to my spouse as described below. Separate Property: (List the property and the value of the property, and check the box to tell the court who should get the property.) You (Petitioner) G FDSG FDSG F DSG FG 6/18/2010 Your Spouse (Respondent) Value 00.453,2 00.523,54 DESCRIPTION OF PROPERTY/ VALUE OF PROPERTY: ___________________________________ ___________________________________ $_________________ $_________________ Page 3 of 5 American LegalNet, Inc. www.FormsWorkFlow.com LJKL;JKL; Case No._____________________________________ You (Petitioner) Your Spouse (Respondent) 00.543,254,3 00.254,325,243 FDSG FSD FDSG FSDG FDSA ___________________________________ ___________________________________ DEBTS INCURRED DURING THE MARRIAGE: (Check one box.) My spouse and I did not incur any community debts during the marriage, OR We should divide the responsibility for the community debts incurred during the marriage as follows:  DESCRIPTION OF DEBT/ AMOUNT OF DEBT: ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ FDSG FDSG FSDG FDSG FDSG FDSG FDSG FDSG FDSG FDSG FDSG FDSG FDSG FSDG FDSG You (Petitioner) Value $_________________ $_________________ $_________________ $_________________ $_________________ $_________________ SEPARATE DEBTS: (Check all boxes that apply.) My spouse and I do not have any debts that were incurred prior to the marriage, OR I have separate debt that I incurred prior to the marriage which should be paid by me as described below: My spouse has separate debt that he or she incurred prior to the marriage which should be paid by my spouse as described below: DESCRIPTION OF DEBT/ AMOUNT OF DEBT: ___________________________________ ___________________________________ ___________________________________ ___________________________________ You (Petitioner) G FDG FDSG FDSG G FDG FDSG FDSG FDSG FDS FDSG FDS 10. Your Spouse (Respondent) Your Spouse (Respondent) Value 00.6 45,6 00.543 00.523 00.6 9. (b) $_________________ $_________________ 00.343,543 00 . 343,242,432 00.434,3 0.436 ,876 ,243,2 432,411 ,176 ,32 00.7 56 9. (a) Value $_________________ $_________________ $_________________ $_________________ TAX RETURNS: After the Judge or Commissioner signs the Order of Legal Separation, the parties will file state and federal taxes as follows: __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ DSAFDSAFDASF DASFADS SAFSFDSA FDSFDSFDAS 11. WRITTEN AGREEMENT: (Check only if true.) My spouse and I have a written agreement signed by both of us about the maintenance of a spouse, and division of property/debt, and I have attached a copy of the written agreement. CONCILIATION REQUIREMENTS: The conciliation requirements under Arizona law either do not apply or have been met. (This statement must be true or you cannot file a Petition for Legal Separation.) REQUESTS TO THE COURT: A. LEGAL SEPARATION: An order of legal separation. B. SPOUSAL MAINTENANCE/SUPPORT (ALIMONY): Order neither party to pay spousal maintenance/support; OR 6/18/2010 Page 4 of 5 American LegalNet, Inc. www.FormsWorkFlow.com LJKL;JKL; Case No.___________________________________ Order spousal maintenance/support to be paid by Petitioner, or Respondent through the Clerk of the Court in the amount of ____________________ per month, and the statutory fee, beginning with the first day of the month after the Judge or Commissioner signs the Legal Separation and continuing until the person receiving the spousal maintenance/support is deceased, or for __________________ months. 00.56 535,423 C. COMMUNITY PROPERTY: Make a fair division of all community property as requested in this Petition. D. COMMUNITY DEBTS: Order each party to pay community debts as requested in the Petition, and to pay any other community debts unknown to the other party. Order each party to pay and hold the other party harmless from debts incurred by him or her since the parties separation on (date): _________________. E. SEPARATE PROPERTY AND DEBTS: Award each party his or her separate property and debt. F. OTHER ORDERS I AM REQUESTING (Explain request here): __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ 44/40/40 AFDSAFDSA FDSAFDSAFDS FDSAFDASFDSA FADS ADFSA OATH OR AFFIRMATION AND VERIFICATION STATE OF ARIZONA County of Mohave ) ) ss. ) I declare under penalty of perjury that the information I have provided is true and correct to the best of my knowledge and belief. SIGNATURE: ___________________________________________ DATE: ________________________________ Sworn to or affirmed before me this ____________ day of _____________,______ by ____________________________________________. My Commission Expires:___________________________ 6/18/2010 ______________________________________ Notary Public / Deputy Clerk Page 5 of 5 American LegalNet, Inc. www.FormsWorkFlow.com