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) _____________________________________ Self, Without a Lawyer OR Representing: Attorney for: Petitioner Respondent SUPERIOR COURT OF ARIZONA MOHAVE COUNTY Regarding the Matter of: ________________________________________ (Name of Petitioner) Case Number:__________________________ PETITION FOR PATERNITY (Check one box only) LEGAL DECISION MAKING, PARENTING TIME, and CHILD SUPPORT LEGAL DECISION MAKING, PARENTING TIME ONLY AND ________________________________________ (Name of Respondent) GENERAL INFORMATION: 1. INFORMATION ABOUT THE PETITIONER Name: _____________________________________________________________________________ Address: _____________________________________________________________________________ County of residence: _________________________________________________________________________ Date of Birth: _____________________________________________________________________________ Occupation: _____________________________________________________________________________ Relationship to minor child(ren) for whom I want the paternity order: Mother I claim to be the Father I am a court-appointed guardian, conservator or "best friend" for the minor child(ren) born out of wedlock 2. INFORMATION ABOUT THE RESPONDENT Name: _____________________________________________________________________________ Address: _____________________________________________________________________________ County of residence: _________________________________________________________________________ Date of Birth: _____________________________________________________________________________ Occupation: _____________________________________________________________________________ Relationship to minor child(ren) for whom I want the LEGAL DECISION MAKING/PARENTING TIME ORDER: Mother Father Other: (explain) ________________________________________________________________ Revised 1/1/2013 Page 1 of 7 American LegalNet, Inc. www.FormsWorkFlow.com Case No.___________________________________ 3. JURISDICTION: WHY I AM FILING THIS COURT CASE IN ARIZONA AGAINST THE OTHER PERSON: (check all that apply) The person is a resident of Arizona I believe that I will personally serve the person in Arizona (see packet on service to know about this) The person agrees to have the case heard here and will file written papers in the court case; The person lived with the minor child(ren) in this state at some time; The person lived in this state and provided pre-birth expenses or support for the minor child(ren); The minor child(ren) live/lives in this state as a result of the acts or directions of the person; The person had sexual intercourse in this state as a result of which the minor child(ren) may have been conceived; The person signed a birth certificate that is filed in this state; The person did any other acts that substantially connect the person with this state (see a lawyer to help you determine this). 4. INFORMATION ABOUT MINOR CHILD(REN) FOR WHOM I WANT PATERNITY ORDER: Name: _____________________________________ Birthdate: (month/day/year)______________________ City, State, Nation of Birth: ______________________ ____________________________________________ Name: _____________________________________ Birthdate: (month/day/year) ______________________ City, State, Nation of Birth: ______________________ ____________________________________________ Name: _____________________________________ Birthdate: (month/day/year) ______________________ City, State, Nation of Birth: ______________________ ____________________________________________ Name: _____________________________________ Birthdate: (month/day/year)______________________ City, State, Nation of Birth: ______________________ ____________________________________________ Name: _____________________________________ Birthdate: (month/day/year)______________________ City, State, Nation of Birth: ______________________ ____________________________________________ Name: _____________________________________ Birthdate: (month/day/year)______________________ City, State, Nation of Birth: ______________________ ____________________________________________ STATEMENTS ABOUT PATERNITY: 5. WHY YOU THINK THE PERSON IS THE FATHER OF THE MINOR CHILD(REN): (check which box applies). AFFIDAVIT: Petitioner and Respondent signed an Affidavit of Paternity acknowledging that Petitioner or Respondent is the minor child(ren)'s natural father. A copy is attached. BIRTH CERTIFICATE: Petitioner or Respondent is named as the natural father on each of the minor child(ren)'s birth certificate(s). Copy (or copies) attached. BLOOD TEST: DNA Testing indicates: Petitioner or Respondent is the minor child(ren)'s natural father. Report(s) of test results attached. PARTIES LIVING TOGETHER: Petitioner and Respondent were not married to each other at any time during the ten months before birth of the minor child(ren). However, the parties lived together during the period(s) when the minor child(ren) could have been conceived. Revised 1/1/2013 Page 2 of 7 American LegalNet, Inc. www.FormsWorkFlow.com Case No._________________________________ SEXUAL INTERCOURSE: Petitioner and Respondent were not living together but had sexual intercourse at the probable date(s) of conception of the minor child(ren). The mother of the minor child(ren) did not have sexual intercourse with anyone else during the periods in which the minor child(ren) could have been conceived. OTHER: (explain)_________________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ 6. ABOUT MARRIAGE AND HUSBAND (if applicable, check one box.) Mother was not married at the time minor child(ren) were born or conceived or at least 10 months before minor child(ren) were born or conceived, OR Mother was married when minor child(ren) were born or conceived or at least 10 months before minor child(ren) were born or conceived, but husband is not father of minor child(ren). Husband is a party