FOR CLERK’S USE ONLY SUPERIOR COURT OF ARIZONA MOHAVE COUNTY _____________________________________ (Name of Petitioner) Case Number: ______________________________ TEMPORARY ORDER FOR (Check all that apply) Child custody Parenting Time Child Support Spousal Maintenance/Support Property and/or Debt Attorney Fees _____________________________________ (Name of Respondent) NOTICE: This is a Court Order that affects your legal rights and responsibilities. Read Carefully. If you disagree with or you do not understand this Order, you may consult an attorney for assistance. THE COURT FINDS: 1. A Sworn “Motion for Temporary Orders” was filed with the court. The court read the Motion, scheduled a hearing, took testimony as appropriate, considered all relevant matters, and issues a Temporary Order. 2. This court has jurisdiction to enter temporary orders regarding child custody, parenting time, child support, and/or spousal maintenance, property or debt, and has jurisdiction over the parties under the law. Where it has the legal power to do so and where it is applicable to the facts of this case, this court has considered, approved, and made Orders relating to child custody, parenting time, child support, spousal maintenance, property, and debt. 3. This order is based on the best interests of any minor children and/or the inability of one spouse to support him or herself or to maintain this action without financial assistance from the other spouse, and because the other spouse refuses to voluntarily provide support. 4. The relation of the party who requested these temporary orders to any children involved in this case is: Mother Father Other Relation:______________________ and if “Other”, the name of that Person is: __________________________________________. Where ever this Order refers to “Other” or “Other Person,” it refers to the individual named above. This Order applies to the children named below. Month/Date/Year of Birth: _____________________________________________ _______________________________ _____________________________________________ _______________________________ _____________________________________________ _______________________________ _____________________________________________ _______________________________ 10/29/09 Page 1 of 5 American LegalNet, Inc. www.FormsWorkFlow.com Case No.______________________________ 5. TEMPORARY CHILD SUPPORT: The court, having considered the best interests of the minor child(ren), makes the following findings regarding payment of temporary child support: In accordance with the Arizona Child Support guidelines, and based upon the Parent’s Worksheet for child Support, the person responsible for payi9ng child support child should pay $________________________ per month, OR Deviation from the Child Support guidelines is appropriate because: Application of the Guidelines is inappropriate or unjust. The parties have signed a written agreement, free of duress and coercion, with knowledge of the amount of support that would have been ordered by the guidelines but for the agreement. The child support order would have been: $________________________ The child support order after deviation is: $________________________ Other Reasons for Deviation from Guideline Amount: ____________________________________________________________________________ ____________________________________________________________________________ 6. TEMPORARY SUPERVISED OR NO PARENTING TIME: (if applicable) Supervised Parenting time between the minor child(ren) and Petitioner Respondent or Other, OR No Parenting time between the minor child(ren) and Petitioner Respondent or Other, is in the best interests of the minor child(ren) for the following reasons: ___________________________________________________________________ __________________________________________________________________________________ __________________________________________________________________________________ THE COURT ORDERS: A. CUSTODY Temporary Joint Legal Custody. There having been no significant acts of domestic violence, Petitioner and Respondent are hereby awarded temporary joint legal custody of the minor child(ren) subject to Mohave County Custody and Visitation Guidelines OR The attached Parenting Plan, OR Temporary Sole Custody of the minors named below is awarded as indicated below: Petitioner B. Respondent Other Names of Minor Children TEMPORARY PARENTING TIME (or for non-parent, “visitation”). Reasonable parenting time to _______________________according to the Mohave County Custody and Visitation Guidelines (OR) Reasonable parenting time to _______________________according to the Parenting Plan attached (OR) Reasonable visitation time to ________________________according to the Parenting Plan attached for person other than parent (OR) 10/29/09 Page 2 of 5 American LegalNet, Inc. www.FormsWorkFlow.com Case No._____________________________ Supervised parenting time (or visitation) to ________________________ but only in the presence of the person named below or other person approved by the court. (OR) Name of Supervisor: __________________________________________________________ Restrictions: ________________________________________________________________ The cost of supervised parenting time shall be paid by: Petitioner or Respondent or Other ________________________________ No parenting time rights to Petitioner or Respondent or Other Other parenting time/visitation as ordered by this court:_____________________________ __________________________________________________________________________________ __________________________________________________________________________________ C. CHILD SUPPORT Mother shall pay child support to the Father Other party Father shall pay child support to the Mother Other party in the amount of $_______________________ per month, payable on the first day of each month beginning the first day of month following the signing of this Order until further order of the court. All child support payments shall be made by Order of Assignment signed this date, along with the statutory handling fee, through the Support Payment Clearinghouse. Any time the full amount is not withheld, the “Obligor” (the person obligated to pay) remains responsible for the full monthly amount ordered, and shall make payments payable to and mail directly to: Support Payment Clearinghouse P.O. box 52107 Phoenix, AZ 85072-2107 Payments must include the obligor’s name, Social Security Number and ATLAS number. Payments not made through the Clearinghouse shall be considered gifts unless otherwise ordered by the court. D. MEDICAL, DENTAL, VISION CARE FOR MINOR CHILDREN Father is responsible for providing: medical dental vision care insurance Mother is 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: Father is ordered to pay ____________%, AND Mother 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. E. MEDICAL AND DENTAL CARE FOR OTHER SPOUSE Petitioner is responsible for providing: medical dental insurance (for other spouse). Respondent is responsible for providing: medical dental insurance (for other spouse). All uninsured medical and dental expenses shall be paid as follows: ____________% by Petitioner, and ____________% by Respondent. 10/29/09 Page 3 of 5 American LegalNet, Inc. www.FormsWorkFlow.com Case No.______________________________ F. Petitioner or SPOUSAL MAINTENANCE/SUPPORT shall be paid by Respondent to the other spouse in the amount of $____________, due on or before the ________ day of every month until further order of this court. ACCESS TO COMMUNITY LIQUID ASSETS (cash or cash held in financial institutions, traveler’s checks, lottery winnings) Wife and husband shall have immediate access to community funds in the proportions (or dollar amounts) listed below, held in these named banks or financial institutions: Name of Financial Institution Name of Account Holder Total ($) in % or Dollar % or Dollar Account Amount to Amount to Husband Wife $ G. $ $ H. I. DISCLOSURE OF COMMUNITY LIQUID ASSETS (Cash or cash held in financial institutions, traveler’s checks, lottery winnings). The Petitioner and Respondent are ordered to disclose to the other party and to the court the name of all financial institutions where funds are held; the name in which the account is held; the account number; and the dollar amount in the account. (To guard against identity theft, financial account numbers may be presented on the “Sensitive Data Sheet,” which is not part of the public record.) PAYMENT OF DEBTS shall be made as follows: Creditor’s Name Names(s) on Account (who the money is owed to) Total Amount Owed Monthly Minimum Payment ($) $ $ $ $ $ J. $ $ % or $ to be Paid by Wife $ $ % or $ to be Paid by Husband $ EXCLUSIVE USE AND POSSESSION OF PROPERTY is granted as follows: To Petitioner if marked under the “P”; to the Respondent if marked under the “R”. P R Residence at (list address): ______________________________________________________ Car described as: ______________________________________________________ Other property-describe ______________________________________________________ Other property-describe ______________________________________________________ Other property-describe ______________________________________________________ Other property-describe ______________________________________________________ K. ATTORNEY FEES Petitioner or Respondent or Other party shall reimburse Petitioner or Respondent or Other party for attorney fees in the amount of $____________, to be paid as follows: ___________________________________________________ __________________________________________________________________________________ __________________________________________________________________________________ 10/29/09 Page 4 of 5 American LegalNet, Inc. www.FormsWorkFlow.com Case No._____________________________ Petitioner If the Respondent or Other Party (named above) contests (files papers to disagree with) these Temporary Orders, he or she shall pay or reimburse the other party(ies) for the costs of defending or maintaining these Orders, including: attorney fees and ________________________. L. THIS ORDER SHALL CONTINUE in effect until further order of this court or until this date: _______________________________ DONE IN OPEN COURT: _______________________ 10/29/09 Page 5 of 5 _____________________________________ Judge/Commissioner of the Superior Court American LegalNet, Inc. www.FormsWorkFlow.com