Name: ___________________________________ Address: _________________________________ City, State, ZIP: ____________________________ Daytime Telephone No: ______________________ Representing Self, Without a Lawyer ARIZONA SUPERIOR COURT, PIMA COUNTY ______________________________________ Case No. _________________ Petitioner and REQUEST FOR PROTECTED ADDRESSS ______________________________________ Respondent I reasonably believe that physical or emotional harm may result to me or my minor child(ren) if my address is not protected from disclosure, and I request that the court order that my address be protected from public disclosure, for the following reasons: [ ] I have a valid Order of Protection against a party in this case issued by the following court (a copy is attached if available): __________________________________________________________________________________________ [ ] I have a valid Order of Protection against a party in this case issued by this court: __________________________________________________________________________________________ [ ] I have a valid Order of Protection against a person not involved in this case issued by the following court (a copy is attached if available): __________________________________________________________________________________________ [ ] I do not have a valid Order of Protection, but want my address protected for the following reasons: __________________________________________________________________________________________ My address is currently unknown to the other party. I have listed my address on a separate sheet of paper for court use. I understand that I have a continuing duty to provide the clerk of the court with a current and correct mailing address where I can be served with process until one of the following events stated in Rule 7(D), Arizona Rules of Family Law Procedure, occurs. __________________________________ Date _______________________________________________ Requestor’s Signature childsupport-Request for Protected Address Revised 10/1/10 1 American LegalNet, Inc. www.FormsWorkFlow.com PERSON WHOSE ADDRESS IS PROTECTED: _______________________________________________ [ ] Petitioner [ ] Respondent ADDRESS TO BE PROTECTED: Street: _________________________________________________________________________ City: _________________________________________________________________________ State, Zip Code : _________________________________________________________________________ Telephone Number: _________________________________________________________________________ childsupport-Request for Protected Address Revised 10/1/10 2 American LegalNet, Inc. www.FormsWorkFlow.com