Name: Mailing Address: Daytime Telephone: Representing Self, Without a Lawyer IN THE SUPERIOR COURT OF ARIZONA, YAVAPAI COUNTY Regarding the Matter of DO ________________________________ Petitioner MOTION FOR SIMPLIFIED TEMPORARY CHILD SUPPORT ORDER [626] [ ] Expedited Process and Respondent THIS MOTION FOR SIMPLIFIED TEMPORARY CHILD SUPPORT ORDER IS FILED BY [ ] PETITIONER OR [ ] RESPONDENT PURSUANT TO RULE 47(I) OF THE ARIZONA RULES OF FAMILY LAW ROCEDURE (ARFLP). NOTICE TO PERSON SERVED WITH THIS MOTION IF YOU WERE SERVED WITHIN THE STATE OF ARIZONA: Pursuant to Rule 47(I), ARFLP, you have 20 days from the day you were served with this Motion to file a Response, a completed Parent Worksheet for Child Support Amount, and, if you request a hearing, a Notice of Hearing. If you fail to do so, a Temporary Child Support Order may be entered against you. IF YOU WERE SERVED OUTSIDE THE STATE OF ARIZONA: Pursuant to Rule 47(I), ARFLP, you have 30 days from the day you were served with this Motion to file a Response, a completed Parent Worksheet for Child Support Amount, and, if you request a hearing, a Notice of Hearing. If you fail to do so, a Temporary Child Support Order may be entered against you. These forms can be obtained at the Yavapai County Self-Service Center. REQUIRED INFORMATION UNDER OATH: 1. A Petition for Dissolution, Legal Separation, Annulment, or Paternity/Maternity was filed or will be filed along with these documents. The facts and allegations stated in the Petition are incorporated herein and support this Motion: Date petition was filed Superior Court of Arizona in Yavapai County Type of petition Page 1 of 3 American LegalNet, Inc. www.FormsWorkflow.com New facts supporting this Motion 2. [ ] (YOU MUST CHECK HERE, AND THIS STATEMENT MUST BE TRUE) To the best of my knowledge, no temporary orders regarding these matters have been entered in any other court, and no court proceedings are pending for temporary orders. 3. [ ] The relief requested in this Motion for Simplified Temporary Child Support Order applies to [ ] each/all child(ren) identified in the Petition above. [ ] only the following child(ren) identified in the Petition above. Name Name Name 4. [ ] Date of Birth Date of Birth Date of Birth Expedited Process requested because THIS IS WHAT I WANT THE COURT TO ORDER: 1. [ ] MEDICAL INSURANCE AND/OR COSTS: An order requiring the opposing party to provide medical, dental and health insurance for the child(ren), at no cost to me, OR to pay all the medical, dental and health expenses reasonably incurred by me for the minor child(ren). 2. [ ] CHILD SUPPORT: An order requiring the other parent to pay to me child support [ ] [ ] [ ] Determined by the current child support Guidelines, according to the Parent's Worksheet for Child Support Amount that I am filing along with this Motion; OR I request a deviation from the Guidelines: [ ] Application of the Guidelines is [ ] inappropriate OR [ ] unjust because OR The parties have signed a written agreement, free of duress or coercion, with knowledge of the amount of support that would have been ordered under the Guidelines. A copy of the agreement is attached. [ ] BASIS FOR REQUEST: This request is based on the best interests of the minor child(ren) and on my inability to support the minor child(ren) or maintain this action without financial assistance from the opposing party, and because the opposing party refuses to voluntarily provide support for the family. 3. [ ] OTHER REASONS: ________________________________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ Superior Court of Arizona in Yavapai County Page 2 of 3 American LegalNet, Inc. www.FormsWorkflow.com REQUEST TO THE COURT, UNDER OATH: 1. To enter a temporary order granting what I requested, until a court hearing can take place on this matter, or until further order of the court. 2. For any other orders of the court that are just. OATH AND VERIFICATION STATE OF ARIZONA County of ________________________ ) ) ss. I, being duly sworn and under oath, state that I have read this Motion. All the statements in the Motion are true and correct and complete to the best of my knowledge and belief. SIGNED: SUBSCRIBED AND SWORN to before me this by My Commission Expires: Superior Court of Arizona in Yavapai County day of , 20 , . Notary Public Page 3 of 3 American LegalNet, Inc. www.FormsWorkflow.com