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