(1) Name of Person Filing: Person filing is the: Petitioner Respondent Mailing Address (if not protected): City, State, Zip Code: Phone Number: I am representing myself, without an attorney (If Attorney) State Bar Number: ___________ __ ___________ ___________ ___________ For Clerk Use Only SUPERIOR COURT OF ARIZONA IN (2) ________________________COUNTY (3) ___________________________ (4) Case No. ATLAS No. ______________________________ Petitioner Respondent REQUEST FOR HEARING AND NOTICE OF HEARING (Simplified Procedure) A Request to Modify Child Support Pursuant to Guidelines Simplified Procedure has been filed. The information provided on the "Parent's Worksheet" that was the basis for the request to modify child support is not accurate. I am attaching the required completed "Parent's Worksheet" that shows what I believe to be accurate information. I request that a hearing be set so that I can explain to the judge or commissioner my position. I further request that costs and fees incurred in responding to this Request for Modification be ordered to be paid by the opposing party. I have read this document and the information is true and correct to the best of my knowledge. (5) COUNTER PETITION: I further request the child support be modified to an amount different from the amount requested by the other party. (6) __________________ Date _______________________________________ Requesting Party's Signature Signed and sworn to or affirmed before me this date: __________________________________ Notary Public My Commission Expires: _____________ OR by: _______________________ By: ______________________________ Deputy Clerk of Superior Court NOTICE OF HEARING (7) The above verified Request for Hearing having been filed, this matter shall be heard: Page 1 of 2 Arizona Supreme Court � Self Service Center July 2013 Request for Hearing and Notice of Hearing American LegalNet, Inc. www.FormsWorkFlow.com DATE AND TIME: PLACE: If either party fails to appear at the hearing after proper notice, the court will take evidence from the party who does appear and make a decision based on the information provided in the Request to Modify Child Support, Request for Hearing, and any oral testimony. Date (Judicial Officer) (8) Upon receipt of the hearing date, I will immediately mail a copy of this Request for Hearing and Notice of Hearing to the other parent or such person's attorney as follows: Name: Address: If one of the parties is using the child support services of the Department of Economic Security, I will also immediately mail a copy of this Request for Hearing and Notice of Hearing to: Division of Child Support Services ATTN: Modification P.O. Box 40458 Phoenix, AZ 85067 (9) __________________________ Date __________________________________________ Requesting Party's Signature Page 2 of 2 Arizona Supreme Court � Self Service Center July 2013 Request for Hearing and Notice of Hearing American LegalNet, Inc. www.FormsWorkFlow.com