Name of Person Filing Document: Your Address: Your City, State, Zip Code: Your Telephone Number: ATLAS Number (if applicable): Attorney Bar Number (if applicable): Representing Self (Without Attorney) OR Attorney for SUPERIOR COURT OF ARIZONA YAVAPAI COUNTY Case No.: ORDER FOR (check one box) (Name of Petitioner) CUSTODY, PARENTING TIME and CHILD SUPPORT CUSTODY AND PARENTING TIME AND (Name of Respondent) THE COURT FINDS: 1. This case has come before this court for a final order, and if necessary the court has taken all testimony needed to enter a final Order. 2. This court has jurisdiction over the parties under the law. 3. Where it has the legal power to do so and where it is applicable to the facts of this case, this court has considered, approved, and made an Order relating to Child Custody, Child Support, Parenting Time and expenses related to the births of the minor child(ren). 4. This Order applies to these minor child(ren): CHILD(REN)’S NAME(S) 5. DATE OF BIRTH PARENT EDUCTION PROGRAM. A. Petitioner has attended the Parent Education Program class as evidenced by the Certificate of Completion in the Court file, OR Petitioner has not attended the Parent Education Program class and shall be denied any requested relief to enforce or modify this Order until Petitioner has completed the class. B. Respondent has attended the Parent Education Program class as evidenced by the Certificate of Completion in the Court file, OR Superior Court of Arizona in Yavapai County August 2010 Page 1 of 4 DRCV81f American LegalNet, Inc. www.FormsWorkFlow.com Case No. C. 6. Respondent has not attended the Parent Education Program class and shall be denied any requested relief to enforce or modify this Order until Respondent has completed the class. DEVIATION FROM CHILD SUPPORT. The Court, having considered the best interests of the child(ren), deviates from the guidelines for the following reasons: Application of the guidelines is inappropriate. Application of the guidelines is unjust. The parties have signed a written agreement with knowledge of the amount of support that would have been ordered by the guidelines but for the agreement. THE COURT MAKES THE FOLLOWING FINDING REGARDING THE DEVIATION: The child support order would have been The child support order after deviation is All parties have signed the agreement free of duress and coercion. $ $ 7. PHYSICAL CUSTODY ADJUSTMENT, COURT APPROVED DISCRETIONARY PARENTING TIME ADJUSTMENT AND/OR OTHER ADJUSTMENTS. (THE COURT MUST MAKE WRITTEN FINDINGS IF ANY OF THESE ADJUSTMENTS ARE MADE.) 8. SUPERVISED OR NO PARENTING TIME . (if applicable) Supervised parenting time between the minor child(ren) and Petitioner OR Respondent or Other No parenting time between minor child(ren) and Petitioner OR Respondent or Other is in the best interests of the minor child(ren) for the following reasons: 9. DRUG CONVICTION WITHIN LAST TWELVE MONTHS: If either party has been convicted of driving under the influence of alcohol or drugs, or was convicted of any drug offense within 12 months of filing the request for custody, the custody, and or parenting time arrangement ordered by this court appropriately protects the minor child(ren). THE COURT ORDERS: 1. CHILD CUSTODY AND PARENTING TIME : A. SOLE CUSTODY: Sole custody of the minor child(ren) is awarded to: Mother or Father as primary custodial parent, subject to parenting time as follows: Superior Court of Arizona in Yavapai County August 2010 Page 2 of 4 DRCV81f American LegalNet, Inc. www.FormsWorkFlow.com Case No. (1) Parenting time to the parent not having custody according to the Parenting Plan attached to and made a part of this Order. OR (2) Supervised parenting time to Mother or Father according to the terms of the Parenting Plan attached to and made a part of this Order, but only in the presence of another person name below or otherwise approved by the court. Name of supervisor: Restriction on parenting time : The cost of supervised parenting time shall be paid by: Mother or Father or shared equally by the parties. OR (3) No parenting time rights to Mother or Father based on the findings above. OR B. JOINT CUSTODY: Petitioner and Respondent agree to act as joint custodians of the minor child(ren), as set forth in the Joint Custody Agreement and Parenting Plan pursuant to A.R.S. Section 25-403., signed by both parties and attached to and made a part of this Order. There have been no significant acts of Domestic Violence under A.R.S. 13-3601 by either parent. The Court adopts the agreed terms of the Joint Custody Agreement. By attaching the Joint Custody Agreement and Parenting Plan to the Order, it becomes part of the final Order and carries the same legal weight as any other Order. 2. CHILD SUPPORT: Mother or Father shall pay child support to the other party in the amount of $ per month, beginning THE FIRST DAY OF THE MONTH following the signing of this Order, according to the Child Support Worksheet attached hereto and incorporated. All child support payments shall be made through the Support Payment Clearinghouse, P.O. Box 52107, Phoenix, Arizona 85072-2107, plus an applicable statutory fee. Payments shall be in equal installments made on the 1st and 15th of each month thereafter through an automatic wage assignment. 3. MEDICAL AND DENTAL INSURANCE, PAYMENTS, AND EXPENSES: Mother or Father is ordered to provide medical and dental insurance for the minor child(ren) as provided for in the Child Support Worksheet attached hereto and incorporated by reference. The party ordered to pay for medical and dental insurance must keep the other party informed of the insurance company’s name, address, and telephone number, and provide the other party with the documents necessary to submit insurance claims. Further, Mother is ordered to pay % and Father is ordered to pay % of all reasonable uncovered and/or uninsured medical, dental, prescription, and other health care expenses for the minor child(ren), including co-payments. 4. FINANCIAL INFORMATION EXCHANGES: The parties shall exchange financial information (tax returns, spousal affidavits, earning statements and/or other related financial statements) every twentyfour months. Superior Court of Arizona in Yavapai County August 2010 Page 3 of 4 DRCV81f American LegalNet, Inc. www.FormsWorkFlow.com Case No. 5. LIMITATION ON JURISDICTION: (check box if applicable) This court cannot make a legal order, without personal service on (the other party) with respect to issues of child support, medical and dental insurance for the minor child(ren) or regarding costs relating to birth of the child(ren). The court reserves the right to enter such orders at such time as the court acquires personal jurisdiction over the Respondent. 6. OTHER ORDERS: This court makes further Orders relating to this matter as follows: FINAL APPEALABLE ORDER. Pursuant to Arizona Rules of Family Law Procedure, Rule 81, this final judgment/decree is settled, approved and signed by the court and shall be entered by the clerk. DONE IN OPEN COURT: JUDGE OR COMMISSIONER If you are the Petitioner and you have a Default Hearing, and the Respondent was personally served with the court papers, meaning that service was not done by “publication”, you must mail or give a copy of this Court Order to the Respondent after the Judge has signed it. You must tell the Court you will do this. By signing below, Petitioner declares that a copy of the Decree will be mailed to Respondent. at the following address: Respondent’s Name: Mailing Address: City, State Zip Code: Petitioner’s Signature: Date: Superior Court of Arizona in Yavapai County August 2010 Page 4 of 4 DRCV81f American LegalNet, Inc. www.FormsWorkFlow.com