Arizona Superior Court, Pinal County Family Court Cover Sheet Pursuant to Rule 4.1 Superior Court Local Rules - Pinal County, please provide the following information. (Type or print) CASE NUMBER DO 2 Judge ATLAS NUMBER(S) PETITIONER’S NAME AND ADDRESS RESPONDENT’S NAME AND ADDRESS Name: Name: Address: Address: City/State/Zip: City/State/Zip: Phone Number: Phone Number: Email Address: Email Address: DOB: DOB: PETITIONER’S ATTORNEY EMERGENCY ORDER SOUGHT Name/State Bar #: Order of Protection Address: Temporary Order City/State/Zip: Other (Specify) Phone Number: Do you or the other party need an interpreter? Yes If yes, what language: Page 1 of 3 No FEES: PAID NOT PAID - REASON Political Subdivision/Government Agency Deferred Waived DO_SDS_COSCPinal_08.04.11 Use only most current version American LegalNet, Inc. www.FormsWorkFlow.com ACTION REQUESTED Check only one box DISSOLUTION (Divorce) D01 With Children D02 Without Children D11 Legal Separation D12 Paternity/Maternity D13 Annulment D14 Custody D15 Order of Protection D16 Foreign Judgment D17 Domesticated Decree D18 Foreign Judgment for Custody D19 Establish Support D20 Habeas Corpus D21 Visitation D40 Emergency Order of Protection D22 Other (Specify) I receive or have received public assistance which may include AFDC, TANF, or AHCCS for my child(ren) or me. Yes No I have a case with the Division of Child Support Enforcement. Yes No If yes, list the case number(s) _________________________________________________________________ Do you currently have ANY other Pinal County Superior Court cases? Yes No If yes, list the case number(s) _________________________________________________________________ Have you ever had ANY other Pinal County Superior Court cases? Yes No If yes, list the case number(s) _________________________________________________________________ PETITIONER'S DECLARATION OF INFORMATION FOR CONCILIATION COURT The wife is pregnant: Yes No The respondent is being served by publication: Yes No Please enter the number of children under the age of 18 of either or both parties who are in custody of either or both parties: NAMES OF MINOR CHILDREN & DATE OF BIRTH: Page 2 of 3 NAMES OF MINOR CHILDREN & DATE OF BIRTH: DO_SDS_COSCPinal_08.04.11 Use only most current version American LegalNet, Inc. www.FormsWorkFlow.com Yes There is an agreement as to the parenting arrangements of the minor children: 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. PLEASE DO NOT INCLUDE THIS FORM WITH CASES THAT HAVE ALREADY BEEN FILED. This form can only be processed at the time of filing New Complaints and Petitions. Revised 6/22/09 Page 3 of 3 DO_SDS_COSCPinal_08.04.11 Use only most current version American LegalNet, Inc. www.FormsWorkFlow.com