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): _________________________________ Self Petitioner OR Respondent Representing SUPERIOR COURT OF ARIZONA MOHAVE COUNTY ______________________________________ Name of Petitioner (in original case) AND ______________________________________ Name of Respondent (in original case) Case Number:__________________________ PETITION TO MODIFY LEGAL DECISION MAKING, PARENTING TIME and CHILD SUPPORT 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 Legal Decision Making / 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 Legal Decision Making / Parenting Time Order should be changed: Mother or Father or Other: (explain) ___________________________________________ 3. Information about the child(ren) for whom I want the Legal Decision Making / Parenting Time Order changed: Child's Name: ______________________________ Child's Name: ______________________________ Child's Name: ______________________________ Child's Name: ______________________________ Birth date:______________ Birth date:______________ Birth date: ______________ Birth date: ______________ Age: ________ Age: ________ Age: ________ Age: ________ Revised: 1/30/2013 Page 1 of 3 Case No._____________________________ 4. Affidavit Regarding Minor Children. The children have resided in Arizona since the entry I have attached an "Affidavit Regarding of the last Arizona Legal Decision Making Order or (if not) Minor Children". 5. Information about the Order I want to change: (Check A or B, then complete the information) A. 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. (month, day, year). Order/decree is dated: Name of state:___________________________________________ Name of county in state:___________________________________ B. 6. DOMESTIC VIOLENCE. No significant domestic violence has occurred or domestic violence has occurred. Explain ___________________________________________________________________________________ 7. WHAT YOUR ORDER NOW SAYS: Put in WORD FOR WORD the part of the decree/order you 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 legal decision making 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. LEGAL DECISION MAKING AND PARENTING TIME. Joint Legal Decision Making. I want the parties to be awarded joint legal decision making of the child(ren) subject to a Parenting Plan to be submitted later. ______________________________________________________________________________ (name(s) of child(ren)) OR Sole legal decision making. Sole legal decision making of (name(s) of child(ren)) should be awarded to Mother Mother Father or or Father or Other and/or Sole legal decision making of ____________________ (name(s) of child(ren)) should be awarded to Other, subject to parenting time as follows: Revised: 1/30/2013 Page 2 of 3 Case No.______________________________ Reasonable parenting time to the parent/party who does not have legal decision making according to the Mohave County Legal Decision Making Guidelines; OR 2. Reasonable parenting time to the parent/party who does not have legal decision making according to the attached Parenting Plan; OR Supervised parenting time but only in the presence of another person; OR 3. 4. No parenting time rights to Mother or Father Supervised parenting time or no parenting time is requested for the following reasons: CHILD SUPPORT. Mother or Father should pay child support to the other party in per month on the first day of every month, beginning the first the amount of $ day of month 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. 1. B. C. MEDICAL, DENTAL, VISION CARE Petitioner should be responsible for providing: medical insurance. Respondent should be responsible for providing: medical insurance. dental dental vision care vision care Medical, dental, and vision care insurance, payments and expenses are based on the information in the Parent's Worksheet for Child Support attach