THE SUPERIOR COURT OF ARIZONA IN YAVAPAI COUNTY Location: [ ] Prescott CASE NUMBER DO [ ] Verde Valley PETITIONER’S INFORMATION RESPONDENT’S INFORMATION Name: Name: Mailing Address: Mailing Address: City/State/Zip: City/State/Zip: Social Security Number: Social Security Number: Phone: Date of Birth: Phone: Date of Birth: PETITIONER’S ATTORNEY FOR OFFICE USE ONLY Name: FEES: Mailing Address: [ ] Paid [ ] Deferred [ ] Government Agency Receipt # City/State/Zip: State Bar No. Phone Amt: $ Entered by # Summons issued [ ] NONE---Pro Per NATURE OF ACTION Place an “X” next to one description below which best describes the nature of the case. DISSOLUTION OF MARRIAGE LEGAL SEPARATION ANNULMENT [ ] WITH CHILDREN D01 [ ] WITH CHILDREN D11 [ ] WITH CHILDREN D13 [ ] WITHOUT CHILDREN D02 [ ] WITHOUT CHILDREN D11 [ ] WITHOUT CHILDREN D13 [ ] PATERNITY AND/OR MATERNITY D12 [ ] CUSTODY AND/OR PARENTING TIME D14 [ ] DOMESTICATED CUSTODY DECREE D17 [ ] FOREIGN JUDGMENT [ ] ESTABLISH SUPPORT D16 D19 [ ] OTHER D22 FOR OFFICE USE ONLY: [ ] Filing Fee [ ] PEP Assessment [ ] Petition/Complaint signed and notarized [ ] Notice of Right to Convert Health Insurance [ ] Preliminary Injunction [ ] Summons (issued) [ ] Notice RE Creditors [ ] Order Re PEP ( if needed) Rev. 11-03 American LegalNet, Inc. www.FormsWorkflow.com