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Petition To Modify Child Custody Parenting Time (Visitation) And Support Form. This is a Arizona form and can be use in Mohave Local County.
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Tags: Petition To Modify Child Custody Parenting Time (Visitation) And Support, Arizona Local County, Mohave
For Clerk’s Use Only
Name of Person Filing:
Mailing Address:
City, State, Zip Code:
Daytime Phone Number:
Evening Phone Number:
_________________________________
ATLAS Number (if applicable):
Attorney Bar Number (if applicable):
Representing
Self
Petitioner OR
Respondent
SUPERIOR COURT OF ARIZONA
MOHAVE COUNTY
Case Number:
Name of Petitioner (in original case)
PETITION TO MODIFY CHILD
CUSTODY, PARENTING TIME
(“VISITATION”) and SUPPORT
AND
Name of Respondent (in original case)
I,
(print your name)
am the
Petitioner or
Respondent or
Other
and make the following statements to the court, under oath:
GENERAL INFORMATION:
1.
Information about Me
Name:
Address:
How I am related to child(ren) for whom the CUSTODY/PARENTING TIME order should be changed:
Mother or
Father or
Other: (explain)
2.
Information about the Other Party
Name:
Address:
How the other party is related to child(ren) for whom the CUSTODY/PARENTING TIME order
should be changed:
Mother or
Father or
Other: (explain)
3.
Information about the child(ren) for whom I want the custody/parenting time
order changed:
Child’s Name
Birth date
Child’s Name
Birth date
March 20, 2006
Age:
Age:
Child’s Name
Birth date
Child’s Name
Birth date
Age:
Age:
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Case No.
4.
Affidavit Regarding Minor Children.
The children have resided in Arizona since the entry
I have attached an “Affidavit Regarding Minor Children”.
of the last Arizona Custody Order or (if not)
5.
Information about the Order I want to change: (Check A or B, then complete the information)
A.
B.
The Order is from the Superior Court in Mohave County.
(month, day, year).
1.
Order/decree is dated:
2.
The name of the judge who signed the order is:
OR
The Order is from the Superior Court in Arizona but from another county or the
Order is not from Arizona. The child(ren) have lived in Arizona for at least six (6)
months before the date I am filing this Petition. I have filed a certified copy of this Order
with the Clerk of the Court, and a copy of the order/decree is attached to this Petition.
Order/decree is dated:
(month, day, year).
Name of state:___________________________________________
Name of county in state:___________________________________
6.
DOMESTIC VIOLENCE.
7.
WHAT YOUR ORDER NOW SAYS: Put in WORD FOR WORD the part of the decree/order you
No significant domestic violence has occurred or
domestic violence
has occurred. Explain
___________________________________________________________________________________
want to change. (Use extra paper if necessary) OR incorporate the Order which is already a part of the
court’s file, and attach a copy of the Order to the judge’s copy of this Petition and all other parties’ copies
of this Petition.
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
8.
WHY THE DECREE/ORDER SHOULD BE CHANGED: These are my reasons why I believe
that a change of custody and/or parenting time is in the best interest of the child(ren) (Use extra pages if
necessary): __________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
9.
REQUESTS I MAKE TO THE COURT:
A.
CUSTODY AND PARENTING TIME.
Joint Legal Custody. I want the parties to be awarded joint legal custody of the child(ren)
subject to a Parenting Plan to be submitted later.
(name(s) of child(ren))
OR
Sole custody. Sole custody of
should be awarded to
Mother
Mother or
March 20, 2006
Father or
(name(s) of child(ren))
Other and/or Sole custody of
(name(s) of child(ren)) should be awarded to
Other, subject to parenting time as follows:
Father or
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Case No.
1.
2.
3.
4.
Reasonable parenting time to the parent/party who does not have custody
according to the Mohave County Custody and Visitation Guidelines; OR
Reasonable parenting time to the parent/party who does not have custody
according to the attached Parenting Plan; OR
Supervised parenting time but only in the presence of another person; OR
No parenting time rights to
Mother or
Father
Supervised parenting time or no parenting time is requested for the following
reasons:
B.
CHILD SUPPORT.
C.
MEDICAL, DENTAL, VISION CARE
Mother or
Father should pay child support to the other party in the amount
per month on the first day of every month, beginning the first day of month
of $
following the filing of this Petition based upon the attached “Child Support Worksheet.” All child
support payments should be made through the Clerk of the Superior Court/Clearinghouse, and will be
subject to an applicable statutory fee through an automatic Order of Assignment.
Petitioner should be responsible for providing:
medical
dental
vision care insurance.
Respondent should be responsible for providing:
medical
dental
vision care insurance.
Medical, dental, and vision care insurance, payments and expenses are based on the information in the
Parent’s Worksheet for Child Support attached and incorporated by reference. The party ordered to pay
must keep the other party informed of the insurance company name, address and telephone number, and
must give the other party the documents necessary to submit insurance claims.
Non-Covered Expenses. Petitioner is ordered to pay __________ %, AND Respondent is ordered to
pay ________ % of all reasonable uncovered and/or uninsured medical, dental, vision care, prescription
and other health care charges for the minor child(ren), including co-payments.
D.
INCOME TAX DEDUCTION. Mother should claim the tax deduction for
(name(s) of child(ren)
every year or
every other year.
Father should claim the tax deduction for
(name(s) of child(ren)
every year or
every other year.
E.
OTHER ORDERS. I request further Orders relating to this matter as follows:
OATH OR AFFIRMATION AND VERIFICATION
I swear or affirm that the information on this document is true and correct under penalty of perjury.
Signature
Date
Sworn to or Affirmed before me this:
by
(date)
My Commission Expires:
Deputy Clerk or Notary Public
March 20, 2006
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