Name: ___________________________________ Address: _________________________________ City, State, ZIP: ____________________________ Daytime Telephone No: ______________________ Representing Self, Without a Lawyer ARIZONA SUPERIOR COURT, PIMA COUNTY ______________________________________________ Petitioner/Plaintiff and ______________________________________________ Respondent/Defendant OBLIGOR NAME: DATE OF BIRTH: ADDRESS: OBLIGEE NAME:______________________________ DATE OF BIRTH: _____________________ ADDRESS:___________________________ ___________________________________ EMPLOYER INFORMATION FIRM:____________________________________ ADDRESS:________________________________ CHILDREN NAME __________________________________________ __________________________________________ __________________________________________ __________________________________________ DATE OF BIRTH _________________________ _________________________ _________________________ _________________________ AGENCY (if applicable) NAME:______________________________ Case No. _________________ OBLIGEE/OBLIGOR FACT SHEET NOTE: THE OBLIGEE/OBLIGOR MUST NOTIFY THE CHILD SUPPORT DIVISION IF ANY CHANGES TO THE ABOVE OCCUR. 1 childsupport-obligee obligor fact sheet.form Revised 10.01.10 American LegalNet, Inc. www.FormsWorkFlow.com