Arizona Superior Court, Pinal County SV Cover Sheet Pursuant to Rule 4.1 Superior Court Local Rules - Pinal County, please provide the following information. (Type or print) CASE NUMBER SV-___________________ ASSIGNED TO HON. _________________________ INITIATING AGENCY'S NAME and ADDRESS Name: Address: City/State/Zip: City/State/Zip: Telephone: Social Security Number: DOB: Name: Address: MINOR'S NAME PETITIONER'S NAME and ADDRESS Name: PETITIONER'S ATTORNEY'S NAME and ADDRESS Name: State Bar #: Address: Address: City/State/Zip: City/State/Zip: Telephone: Telephone NATURE OF ACTION Place an "X" next to the one which describe the nature of the case. SEVERANCE __________ SV1 Page 1 of 2 � Superior Court of Arizona in Pinal County August 30, 2010 ALL RIGHTS RESERVED SV Petition to Terminate Parental Rights Use only most current version American LegalNet, Inc. www.FormsWorkFlow.com NAMES OF ADDITIONAL MINORS Soc. Sec. # BIRTH DATES OF ADDITIONAL MINORS: ________________________________ ________________________________ ________________________________ ________________________________ ________________________________ _______________ _______________ _______________ _______________ _______________ _____________________________________ _____________________________________ _____________________________________ _____________________________________ _____________________________________ To the best of my knowledge, all information is true and correct ________________________________________________________ Attorney / ProPer Signature NOTICE Effective September 8, 1992 and pursuant to Pinal County Superior Court 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 court records and statistics, 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 05-08-02 Page 2 of 2 � Superior Court of Arizona in Pinal County August 30, 2010 ALL RIGHTS RESERVED SV Petition to Terminate Parental Rights Use only most current version American LegalNet, Inc. www.FormsWorkFlow.com