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 Petitioner Respondent SUPERIOR COURT OF ARIZONA MOHAVE COUNTY Regarding the Matter of: ________________________________________ (Name of Petitioner) AND ________________________________________ (Name of Respondent) Case Number:__________________________ PETITION TO ESTABLISH (Check one box only) LEGAL DECISION MAKING PARENTING TIME and CHILD SUPPORT LEGAL DECISION MAKING PARENTING TIME ONLY 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 LEGAL DECISION MAKING / PARENTING TIME ORDER: Petitioner Respondent Other: (explain) ________________________________________________________________ 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: Petitioner Respondent Other: (explain) ________________________________________________________________ Revised: 7/22/15 Page 1 of 6 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 LEGAL DECISION MAKING / PARENTING TIME ORDER: Name:______________________________________ Birthdate: ___________________________________ Current Address: _____________________________ ___________________________________________ County of residence: __________________________ Petitioner: __________________________________ Respondent:_________________________________ Name:______________________________________ Birthdate:_ __________________________________ Current Address: _____________________________ ___________________________________________ County of residence: __________________________ Petitioner: __________________________________ Respondent:_________________________________ Name: _______________________________________ Birthdate: _____________________________________ Current Address: _______________________________ _____________________________________________ County of residence: ____________________________ Petitioner: ____________________________________ Respondent:___________________________________ Name: _______________________________________ Birthdate: _____________________________________ Current Address: _______________________________ _____________________________________________ County of residence: ____________________________ Petitioner: ____________________________________ Respondent:___________________________________ STATEMENTS ABOUT PATERNITY AND CHILD SUPPORT: 5. PATERNITY WAS ESTABLISHED BY: (check one box). (A copy of any Order or document referenced here should already be in the court file or attached.) A Court Order for Paternity from this county or previously transferred to this county stating that ____________________________________ is the natural father of the minor child(ren). (A.R.S. � 25502(c)) Both parents signing an Acknowledgment of Paternity through the Hospital Paternity Program or other means provided by law after July 18, 1996, and a birth certificate listing the name of the father was issued as a result. We do not have an Order of Paternity, but we do have a Child Support Order. Parties were legally married when the minor child(ren) was (were) born, conceived or adopted.* *NOTE: If married when minor child(ren) born, conceived or adopted, and no Decree of Divorce or Separation has been issued, STOP! Do not use these forms unless advised to do so by an attorney. Requests for legal decision making and visitation (parenting time) must generally be filed as part of a case for Separation or Divorce. Revised: 7/22/15 Page 2 of 6 American LegalNet, Inc. www.FormsWorkFlow.com Case No.____________________________________ 6. INFORMATION ABOUT CHILD SUPPORT FOR MINOR CHILD(REN): (check one box) An Order for Child Support is dated _____________ from (name of court) ________________________ which states that child support is established and does not need to be changed. An Order for Child Support is dated _____________from (name of court) __________________________ which states that child support is established and does need to be changed. To my knowledge there is no Child Support Order for the minor child(ren) and the court should order child