Download Free Print-Only PDF OR Purchase Interactive PDF Version of this Form
Complaint For Paternity With Custody Parenting Time And Child Support Form. This is a Arizona form and can be use in Pima Local County.
Loading PDF...
Tags: Complaint For Paternity With Custody Parenting Time And Child Support, Arizona Local County, Pima
Name: ___________________________________
Address: _________________________________
City, State, ZIP: ____________________________
Daytime Telephone No: ______________________
Representing Self, Without a Lawyer
ARIZONA SUPERIOR COURT, PIMA COUNTY
______________________________________
Case No. _________________
Petitioner/Plaintiff
and
COMPLAINT FOR PATERNITY
WITH CUSTODY, PARENTING
TIME AND CHILD SUPPORT
______________________________________
Respondent/Defendant
1.
GENERAL INFORMATION:
INFORMATION ABOUT ME, THE PLAINTIFF
Name: ______________________________________
Address: _____________________________________________________________________
County of residence: ________________________
Date of Birth: ___________________
Occupation: _______________________________
My relationship to child(ren) for whom I want the paternity order:
I am the Mother
I am the Father
I am a court-appointed guardian for the child(ren)
INFORMATION ABOUT THE OTHER PARTY, THE DEFENDANT
Name: ______________________________________
Address: _____________________________________________________________________
County of residence: ________________________
Date of Birth: ___________________
Occupation: _______________________________
Defendant’s relationship to the child(ren) for whom I want the paternity order:
The Defendant is the Mother
The Defendant is the Father
The Defendant is a court-appointed guardian for the child(ren)
The Defendant is __________________________________
1
paternitycomplaint.form
Revised 01.03.08
American LegalNet, Inc.
www.FormsWorkflow.com
INFORMATION ABOUT THE CHILD(REN) FOR WHOM I WANT THE PATERNITY ORDER:
Name__________________________________
Name ____________________________________
Birthdate_______________________________
Birthdate__________________________________
Current Address:_________________________
Current Address:___________________________
______________________________________
_________________________________________
County of residence: _____________________
County of residence: ________________________
Father:_________________________________
Father:___________________________________
Mother:________________________________
Mother:___________________________________
Name__________________________________
Birthdate_______________________________
Current Address:_________________________
______________________________________
County of residence: _____________________
Father:_________________________________
Mother:________________________________
2.
Name ____________________________________
Birthdate__________________________________
Current Address:___________________________
_________________________________________
County of residence: ________________________
Father:___________________________________
Mother:___________________________________
JURISDICTION
This Court has jurisdiction under A.R.S. § 25-623 to order the non-custodial party to pay child support
because:
That person is a resident of Arizona
I believe I will personally serve that person in Arizona
That person agrees to have the case heard here and will file written court papers in this case
That person resided with the child in this state
That person resided in this state and provided pre-birth expenses or support for the child
The child resides in this state as the result of the acts or directives of that person
That person had sexual intercourse in this state and the child may have been conceived by that act
of intercourse
That person signed a birth certificate that is filed in this state
That person did other acts which substantially connect that person with this state
This Court has jurisdiction to decide child custody matters under Arizona law, A.R.S. §§ 25-401, 25-801
and/or 25-1001 et seq.
2
paternitycomplaint.form
Revised 01.03.08
American LegalNet, Inc.
www.FormsWorkflow.com
3.
STATEMENTS ABOUT PATERNITY:
WHY YOU THINK
PLAINTIFF
(Check all boxes which apply)
DEFENDANT IS THE FATHER OF THE CHILD(REN):
AFFIDAVIT: Plaintiff and Defendant signed an Affidavit of Paternity acknowledging that
Plaintiff
Defendant is the child(ren)'s natural father. (Attach a copy)
BIRTH CERTIFICATE: ___________________________ is named as the natural father on the
child(ren)'s birth certificate(s), which have been signed by both parties. (Attach a copy of each)
DNA/BLOOD TEST: The parties had DNA (Deoxyribonucleic Acid) Testing administered and
______________________________ is shown to be the minor child(ren)'s natural father. (Attach a
copy of the test results)
PARTIES LIVING TOGETHER: Plaintiff and Defendant were not married to each other at any time
during the ten months before birth of the child(ren). However, the parties lived together during the
period(s) when the child(ren) could have been conceived.
SEXUAL INTERCOURSE: Plaintiff and Defendant were not living together but had sexual
intercourse at the probable date of conception of the child(ren). The mother of the children did not
have sexual intercourse with anyone else during the period in which the child(ren) could have been
conceived.
OTHER (explain):
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
4.
ABOUT MARRIAGE AND HUSBAND (if applicable) -- check one box.
Mother was not married at the time the child(ren) were born or conceived or at least 10 months
before child(ren) were born or conceived, OR
Mother was married when child(ren) were born or conceived or at least 10 months before child(ren)
were born or conceived, but husband is not father of child(ren).
Husband is a party to this court case because of marriage.
5.
OTHER STATEMENTS MADE TO THE COURT:
MEDICAL EXPENSES:
THERE ARE
THERE ARE NOT unreimbursed medical expenses
incurred by the mother, resulting from the birth of the minor child(ren) . If there are, these costs
and expenses should be awarded against
PLAINTIFF
DEFENDANT according to law, A.R.S.
§25-809.
OTHER EXPENSES: The parties should be ordered to divide between them any uninsured medical,
dental, or health expenses, reasonably incurred for the minor child(ren), in proportion to their
respective incomes.
DOMESTIC VIOLENCE: (if you are asking for joint custody, this statement must be true)
Domestic violence has not occurred between the parties.
VENUE: This is the proper court to bring this lawsuit under Arizona law because it is the county of
residence of the Plaintiff and Defendant or the child(ren).
3
paternitycomplaint.form
Revised 01.03.08
American LegalNet, Inc.
www.FormsWorkflow.com
6.
REQUESTS I MAKE TO THE COURT:
PATERNITY: Order that _____________________________________________ is the natural
father of the minor children.
BIRTH CERTIFICATE:
Order that the name of ____________________________________ be
added to each child's birth certificate.
LAST NAME:
Order that each child's last name be changed to __________________________;
CHILD CUSTODY AND PARENTING TIME: Award custody and parenting time of the children
common to the parties and less than 18 years old as follows:
SOLE CUSTODY of the minor child(ren) awarded to:
parenting time as follows:
Plaintiff OR
Defendant, subject to
Reasonable parenting time to the parent not having custody, according to the terms of the
Parenting Plan attached to this Petition
OR
Supervised parenting time between the child(ren) and the
Plaintiff OR
Defendant is in
the best interest of the child(ren) because ________________________________________
The cost of supervised parenting time will be paid by the parent being supervised;
the
parent having custody;
shared equally by the parties.
OR
No parenting time to the parent not having custody is in the best interest of the child(ren)
because _________________________________________________________________
JOINT CUSTODY: Plaintiff and Defendant agree to act as joint custodians of the child(ren) as
set forth in the Joint Custody Agreement or Parenting Plan signed by the parties, and attached to
this Complaint.
CHILD SUPPORT: Order that child support shall be paid by:
Plaintiff
Defendant to
Plaintiff
Defendant
in an amount as determined by the court under the Arizona Child Support Guidelines (Child Support
Order to be attached to the Paternity Order). Support payments to begin on the first day of the
month after the Judge or Commissioner signs the Paternity Order or on the first day of the month
after service of the Complaint with all payments, plus the statutory handling fee, to be paid through
The Support Payment Clearinghouse, PO Box 52107, Phoenix, Arizona 85072-7107 to be paid by
automatic wage assignment.
EXPENSES OF MOTHER:
Order that
Plaintiff
Defendant pay a reasonable amount to cover unreimbursed expenses
incurred by the mother related to the birth of each child(ren).
INSURANCE AND HEALTH CARE EXPENSES FOR CHILDREN:
Order that
Plaintiff
Defendant shall pay for medical and dental insurance coverage for the child(ren) common to the
parties and less than the age of 18 years old. Plaintiff and Defendant will pay for all reasonable
unreimbursed medical, dental, and heath-related expenses incurred for the child(ren) in proportion to
their respective incomes as described on the Parents' Worksheet, which shall be submitted with the
Paternity Order.
4
paternitycomplaint.form
Revised 01.03.08
American LegalNet, Inc.
www.FormsWorkflow.com
TAX EXEMPTION: The parties shall claim as income tax dependency exemptions on federal and
state income tax returns as follows:
Parent entitled to claim Name of child
Current tax year
Later tax years
Plaintiff
Defendant
________
_______________
_______________
Plaintiff
Defendant
________
_______________
_______________
Plaintiff
Defendant
________
_______________
_______________
Plaintiff
Defendant
________
_______________
_______________
TESTING and COSTS: Order that if paternity is contested, Plaintiff and Defendant be ordered to
submit to such a blood and tissue tests as may be necessary by this court to establish paternity,
AND that Defendant must pay all costs and expenses of this lawsuit under Arizona law, A.R.S.§25809, if he/she unsuccessfully contests these proceedings, including the costs of the blood tests or
other genetic testing; filing each child’s birth certificate; attorney’s fees and court costs.
OTHER ORDERS THAT I AM REQUESTING: (explain request here)
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
OATH AND VERIFICATION OF PLAINTIFF:
STATE OF ARIZONA
County of Pima
)
) ss.
)
I, _____________________________, the Plaintiff, being duly sworn and under oath, state that I have read this
Complaint. All the statements in the Complaint are true, correct and complete to the best of my knowledge and belief.
_______________________________________________
Plaintiff
Subscribed and sworn to before me this ________ day of ________________, 20___ by the Plaintiff,
_____________________________________.
My Commission Expires:
_____________________________________________
Notary Public
____________________
5
paternitycomplaint.form
Revised 01.03.08
American LegalNet, Inc.
www.FormsWorkflow.com