Arizona Superior Court, Pinal County Adoption Cover Sheet Pursuant to Rule 4.1 Superior Court Local Rules - Pinal County, please provide the following information. (Type or print) CASE NUMBER AD 2 Judge INITIATING AGENCY NAME and ADDRESS MINOR’S NAME and ADDRESS Name: Name: Address: Address: City/State/Zip: City/State/Zip: Telephone: DOB: PETITIONER'S NAME and ADDRESS: PETITIONER'S ATTORNEY NAME and ADDRESS: Name: Name / State Bar#: Address: Address: City/State/Zip: City/State/Zip: Social Security Number: Telephone: DOB: FEES: [ ] PAID [ ] NOT PAID - REASON: [ ] Political Subdivision/Government Agency [ ] Deferred [ ] Waived NATURE OF ACTION Place an "X" next to the description below which describes the nature of the case. ADOPTION _____ AD1 Minor _____ AD2 Ward of Court Page 1 of 2 American LegalNet, Inc. www.FormsWorkflow.com NAMES OF ADDITIONAL WARDS BIRTH DATES OF MINOR CHILDREN ______________________________________ ______________________________ ______________________________________ ______________________________ ______________________________________ ______________________________ ______________________________________ ______________________________ ______________________________________ ______________________________ ______________________________________ ______________________________ ______________________________________ ______________________________ There is an agreement as to the parenting arrangements of the minor children: [ ] YES [ ] NO To the best of my knowledge, all information is true and correct. ___________________________________________________ Attorney / Pro Per Signature NOTICE Effective September 8, 1992 and pursuant to Superior Court (Pinal County), Administrative Order No. 92-15, the Superior Court requires that a “Cover Sheet”, which categorizes the cause of action, accompany any new action filed with the Superior Court in Pinal County For this purpose, this form has been developed. The cover sheet will result in increased accuracy of courts records and statistics, and and in reduced processing time for new case filings. Forms will be made available at the Clerk of the Superior Court’s Filing Counter. PLEASE DO NOT INCLUDE THIS FORM WITH CASES WHICH HAVE ALREADY BEEN FILED. This form can only be processed at the time of filing New Complaints and Petitions. Thank you for assisting us with our efforts to improve service. Rev 01/26/06 Page 2 of 2 American LegalNet, Inc. www.FormsWorkflow.com