Name: Mailing Address: Daytime Telephone: Representing Self, Without a Lawyer IN THE SUPERIOR COURT OF ARIZONA, YAVAPAI COUNTY Regarding the matter of the custody of Minor Child(ren) _ Mother Father __________________________________ Applicant _______________________________________ ) ) ) ) ) ) ) ) ) ) ) ) ) ) ) DO ___________________ ORDER REGARDING PETITION TO ESTABLISH NON-PARENT CUSTODY This matter has come before this Court for an order regarding custody. The Court [ ] has taken all testimony and reviewed all evidence needed to enter an order, or [ ] has determined testimony is not needed to enter an order. THE COURT FINDS: 1. JURISDICTION. This Court has jurisdiction under the law because: [ ] it is the county of residence of the child(ren); [ ] other [ ] This Court does not have jurisdiction. 2. LOCO PARENTIS. [ ] Applicant stands in loco parentis to the child(ren). [ ] Applicant does not stand in loco parentis to the child(ren). Specific findings 3. BEST INTEREST(S) OF CHILD(REN). It [ ] would OR [ ] would not be significantly detrimental to the child(ren) to remain or be placed in the custody of either of the child(ren)'s living legal parents who wish to retain or obtain custody because Superior Court of Arizona in Yavapai County January 2006 Page 1 of 4 DRNPEC81f American LegalNet, Inc. www.FormsWorkFlow.com 4. CURRENT CUSTODY ORDERS. [ ] [ ] A custody order has been entered or approved within the past year, but the child(ren)'s present environment may seriously endanger the child(ren)'s physical, mental, emotional or moral health because [ ] 5. No custody order concerning the child(ren) has been entered or approved by a court of competent jurisdiction within a year previous to the filing of the Petition. Other OTHER REQUIREMENTS. [ ] [ ] The parents were not married to each other at the time of the child(ren)'s birth(s) AND has been legally established as the father of the child(ren). [ ] The child(ren)'s legal parents were not married to each other at the time the Petition was filed. [ ] There is a pending proceeding for dissolution of marriage or for legal separation of the legal parents at the time I file this Petition. [ ] 6. The child(ren)'s [ ] Mother [ ] Father is deceased. Notice was properly given to all interested parties. CUSTODY/PARENTING TIME RESTRICTIONS. [ ] Supervised parenting time between the child(ren) and [ ] Father interests of the child(ren) because [ ] No parenting time between the child(ren) and [ ] Father interests of the child(ren) because [ ] Mother is in the best [ ] Mother is in the best [ ] If custody is awarded and A.R.S. 25-403.04 - 25-403.09 applies, this Court makes the following findings 7. Other Superior Court of Arizona in Yavapai County January 2006 Page 2 of 4 DRNPEC81f American LegalNet, Inc. www.FormsWorkFlow.com THEREFORE, IT IS ORDERED: 1. [ ] Awarding custody of the minor child(ren) to _______________________________________, subject to parenting time with the legal parents as follows: MOTHER 1. [ ] 2. 3. [ ] [ ] Reasonable parenting time pursuant to the Yavapai County Child Access Guidelines; Reasonable parenting time pursuant to the attached Parenting Plan; Supervised parenting time. Supervised parenting time is in the best interest(s) of the child(ren) because unrestricted parenting time would seriously endanger the child(ren)'s physical, mental, moral or emotional health. [ ] Name of person who will supervise [ ] The cost of supervised parenting time shall be paid by OR [ ] Respondent OR [ ] shared equally. 4. [ ] 5. 6. [ ] [ ] No parenting time: (check and explain ONLY if you want the other party to have no parenting time): No parenting time between the child(ren) and the other party is in the best interests of the child(ren) because any parenting time would seriously endanger the child(ren)'s physical, mental, moral or emotional health. Does not apply Court-ordered discretionary Parenting Time Adjustments [ ] Petitioner FATHER 1. [ ] 2. 3. [ ] [ ] Reasonable parenting time pursuant to the Yavapai County Child Access Guidelines; Reasonable parenting time pursuant to the attached Parenting Plan; Supervised parenting time. Supervised parenting time is in the best interest(s) of the child(ren) because unrestricted parenting time would seriously endanger the child(ren)'s physical, mental, moral or emotional health. [ ] Name of person who will supervise [ ] The cost of supervised parenting time shall be paid by OR [ ] Respondent OR [ ] shared equally. Superior Court of Arizona in Yavapai County January 2006 Page 3 of 4 [ ] Petitioner DRNPEC81f American LegalNet, Inc. www.FormsWorkFlow.com 4. [ ] 5. [ ] No parenting time: (check and explain ONLY if you want the other party to have no parenting time): No parenting time between the child(ren) and the other party is in the best interests of the child(ren) because any parenting time would seriously endanger the child(ren)'s physical, mental, moral or emotional health. Does not apply 6. [ ] Court-ordered discretionary Parenting Time Adjustments 2. [ ] Denying the Petition to Establish Non-Parent Custody. 3. [ ] Other Date: Judge/Judge Pro Tem of the Superior Court Superior Court of Arizona in Yavapai County January 2006 Page 4 of 4 DRNPEC81f American LegalNet, Inc. www.FormsWorkFlow.com