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 TO ESTABLISH PARENTING TIME 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 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 PARENTING TIME ORDER: Name: _____________________________________ Birthdate: (month/day/year)______________________ City, State, Nation of Birth: ______________________ ____________________________________________ County of residence: ___________________________ Father: ______________________________________ Mother:______________________________________ Name: _____________________________________ Birthdate: (month/day/year)______________________ City, State, Nation of Birth: ______________________ ____________________________________________ County of residence: ___________________________ Father: ______________________________________ Mother:______________________________________ Name: _____________________________________ Birthdate: (month/day/year)______________________ City, State, Nation of Birth: ______________________ ____________________________________________ County of residence: ___________________________ Father: ______________________________________ Mother:______________________________________ Name: _____________________________________ Birthdate: (month/day/year)______________________ City, State, Nation of Birth: ______________________ ____________________________________________ County of residence: ___________________________ Father: ______________________________________ Mother:______________________________________ STATEMENTS ABOUT PATERNITY AND CHILD LEGAL DECISION MAKING 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 minor child(ren), (A.R.S. § 25-501(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 (A.R.S. § 36-334). We do not have an order of paternity, but we do have a child support order. (See instructions) Parties were legally married when minor child(ren) was (were) born, conceived or adopted.* Revised: 1/1/2013 Page 2 of 6 American LegalNet, Inc. www.FormsWorkFlow.com Case No.____________________________________ *NOTE: If married when minor child(ren) were 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. 6. INFORMATION ABOUT LEGAL DECISION MAKING OF THE MINOR CHILD(REN): (check one box) Mother has had physical legal decision making of the minor child(ren) for the last 6 months, and I do not contest physical legal decision making. Father has had physical legal decision making of the minor child(ren) for the last 6 months, and I do not contest physical legal decision making. A person other than mother or father has had physical legal decision making of the minor child(ren) for the last 6 months, because of a court case, and I do not contest physical legal dec