Page 1 of 3 DOFCCSCOSCPinal03.06.18 Use only most current version Arizona Superior Court, Pinal County Family Court Cover Sheet CASE NUMBER S1100DO2 Judge ATLAS NUMBER(S) PETITIONER222S NAME AND ADDRESS RESPONDENT222S NAME AND ADDRESS Name: Name: Address: Address: City/State/Zip: City/State/Zip: Phone Number: Phone Number: Email Address: Email Address: DOB: DOB: PETITIONER222S ATTORNEY EMERGENCY ORDER SOUGHT Name/State Bar #: Order of Protection Address: Temporary Order City/State/Zip: Other Phone Number: (Specify) Do you or the other party need an interpreter? FEES: PAID NOT PAID - REASON Yes No Political Subdivision/Government Agency If yes, what language: Deferred Waived ACTION REQUESTED: Check Only One Box DISSOLUTION (Divorce) With Children Without Children Legal Separation Paternity/Maternity Annulment Legal Decision-Making American LegalNet, Inc. www.FormsWorkFlow.com Page 2 of 3 DOFCCSCOSCPinal03.06.18 Use only most current version Order of Protection Foreign Judgment Domesticated Decree Foreign Judgment for Legal Decision-Making Establish Support Habeas Corpus Visitation Emergency Order of Protection 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 Legal American LegalNet, Inc. www.FormsWorkFlow.com Page 3 of 3 DOFCCSCOSCPinal03.06.18 Use only most current version Decision-Making of either or both parties: NAMES OF MINOR CHILDREN & DATE OF BIRTH: NAMES OF MINOR CHILDREN & DATE OF BIRTH: 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 (If no attorney, your signature is required) 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 American LegalNet, Inc. www.FormsWorkFlow.com