FOR CLERK'S USE ONLY Name of Person Filing: _____________________________________________ Mailing Address: _____________________________________________ City, State, Zip Code: _____________________________________________ Day/Evening Phone Number: __________________________________________ SUPERIOR COURT OF ARIZONA MOHAVE COUNTY ________________________________________ (Name of Petitioner) Case Number: ________________________________ RESPONSE TO PETITION FOR LEGAL SEPARATION WITH MINOR CHILDREN ________________________________________ (Name of Respondent) STATEMENTS TO THE COURT, UNDER OATH GENERAL INFORMATION: 1. ABOUT MY SPOUSE, THE PETITIONER: Name: Address: ______________________________________________________________________________ ______________________________________________________________________________ County of Residence: _________________________________________________________________________ Date of Birth: ______________________________________________________________________________ Occupation(s): ______________________________________________________________________________ Starting with today, number of months/years in a row my spouse has lived in Arizona: ______________________ 2. ABOUT ME, THE RESPONDENT Name: ______________________________________________________________________________ Address: ______________________________________________________________________________ County of Residence:__________________________________________________________________________ Date of Birth: ______________________________________________________________________________ Occupation(s): ______________________________________________________________________________ Starting with today, number of months/years in a row I have lived in Arizona: _____________________ 3. ABOUT OUR MARRIAGE Date of Marriage: _____________________________________________________________________________ City and state or county where we were married:_____________________________________________________ 4. ABOUT THE LEGAL SEPARATION (check one box) I want to be legally separated from my spouse, OR I do not want to be legally separated from my spouse because my marriage is over and I want to be divorced. INFORMATION ABOUT PROPERTY AND DEBTS Instructions: You must be specific. You must describe the property and debt that should go to you or be paid by you and then check the box. You must then describe the property and debt that should go to or be paid by your spouse, and check the box. For example, under household furnishin you could say, blue and white living room sofa, and then check the box to say whether it should go to you or to your spouse. Never list an item and che both the Petitioner and the Respondent box. Page 1 of 8 Revised: 1/1/2013 American LegalNet, Inc. www.FormsWorkFlow.com Case No.____________________________________ 5a. COMMUNITY PROPERTY: (check one box) My Spouse and I did not acquire any community property during the marriage, OR My spouse and I acquired community property during our marriage, and we should divide it as follows: Description of property/ Value of property: Real estate at: _________________________ Legal Description: _________________________ ________________________________________ My Spouse (Petitioner) Me (Respondent) Value $______________ Real estate at: _________________________ Legal Description: _________________________ ________________________________________ Household furniture and appliances: ________________________________________ ________________________________________ ________________________________________ ________________________________________ Household furnishings: ________________________________________ ________________________________________ ________________________________________ ________________________________________ Other items: ________________________________________ ________________________________________ ________________________________________ ________________________________________ Pension/retirement fund/profit sharing/stock/401k: ________________________________________ ________________________________________ ________________________________________ ________________________________________ Motor vehicles: Make: ___________________________________ Model:___________________________________ VIN Number:______________________________ Lien Holder:_______________________________ Make: ___________________________________ Model:___________________________________ VIN Number:______________________________ Lien Holder:_______________________________ $______________ $______________ $______________ $______________ $______________ $______________ $______________ $______________ $______________ $______________ $______________ $______________ $______________ $______________ $______________ $______________ $______________ $______________ $______________ Page 2 of 8 Revised: 1/1/2013 American LegalNet, Inc. www.FormsWorkFlow.com Case No.____________________________________ 5b. SEPARATE PROPERTY. (Check all boxes that apply.) I do not have any property that I brought into the marriage or separate property. My spouse, the Petitioner does not have any property that he or she brought into the marriage or separate property. I have property that I brought into the marriage or I have separate property. I want this property awarded to me as described below. Separate Property: (List the property and the value of the property, and check the box to tell the Court who should get the property.) Description of property/ Value of property: ____________________________________ ____________________________________ ____________________________________ ____________________________________ My Spouse (Petitioner) Me (Respondent) Value $______________ $______________ $______________ $______________ 6a. COMMUNITY DEBTS: (Check one box) My spouse and I did not incur any community debts during the marriage, OR We should divide the responsibility for the debts incurred during the marriage as follows: Description of debt/ Amount of debt: ____________________________________ ____________________________________ ____________________________________ ____________________________________ ____________________________________ ____________________________________ My Spouse (Petitioner) Me (Respondent) Value $______________ $______________ $______________ $______________ $______________ $______________ 6b. SEPARATE DEBTS. (Check all boxes that apply.) My spouse and I