Name: Mailing Address: Daytime Telephone ATLAS #: Representing Self, Without a Lawyer IN THE SUPERIOR COURT OF ARIZONA, YAVAPAI COUNTY Regarding the matter of DO PETITION FOR LEGAL SEPARATION OF A NON-COVENANT MARRIAGE WITH MINOR CHILDREN Petitioner and [ ] and Request for Order of Paternity [624] Respondent STATEMENTS TO THE COURT, UNDER OATH 1. INFORMATION ABOUT ME, THE PETITIONER Name: Date of Birth Address: Occupation: yrs. How long I, the Petitioner, have lived in Arizona: [ ] The Petitioner is enlisted in the military, and [ ] has OR been deployed for at least one day during the past 6 months. 2. mos. [ ] has not INFORMATION ABOUT MY SPOUSE, THE RESPONDENT Name: Date of Birth Address: Occupation: How long I, the Respondent, have lived in Arizona: [ ] yrs. The Respondent is enlisted in the military, and [ ] has OR been deployed for at least one day during the past 6 months. 3. [ ] has not INFORMATION ABOUT OUR MARRIAGE Date of Marriage: City and state or country where married: [ ] We do not have a covenant marriage. 4. mos. RESIDENCY REQUIREMENT [ ] I live, and/or [ ] my spouse lives or is stationed while a member of the Armed Forces, in Arizona at the time I file this Petition. Superior Court of Arizona in Yavapai County September 2007 Page 1 of 11 American LegalNet, Inc. www.FormsWorkflow.com INFORMATION ABOUT PROPERTY AND DEBTS: 5a. PROPERTY ACQUIRED DURING THE MARRIAGE: [ ] My spouse and I did not acquire any community property during the marriage. Go on to 5b. [ ] My spouse and I acquired community property during our marriage, and we should divide it as follows: (List the property and the value of the property, and check the box to tell the Court who should get the property.) DESCRIPTION OF PROPERTY/ VALUE OF PROPERTY: SELL & SPLIT [ ] [ ] [ ] [ ] Real estate address: WIFE [ ] [ ] [ [ [ [ [ [ [ [ [ [ [ [ [ [ [ [ ] HUSBAND [ [ [ [ [ [ [ [ [ [ [ [ [ [ [ [ [ [ [ [ [ [ [ [ [ [ [ [ [ [ Legal Description: Real estate address: Legal Description: [ ] Household furniture and appliances: Superior Court of Arizona in Yavapai County September 2007 ] ] ] ] ] ] ] ] ] ] ] ] ] ] ] ] ] ] ] ] ] ] ] ] ] ] ] ] ] ] ] ] ] ] ] ] ] ] ] ] ] ] ] ] ] Page 2 of 11 American LegalNet, Inc. www.FormsWorkflow.com HUSBAND [ ] WIFE SELL & SPLIT Household furnishings: [ [ [ [ [ [ [ [ [ [ [ ] [ [ [ [ [ [ [ [ [ [ ] ] ] ] ] ] ] ] ] ] ] ] ] ] [ [ [ [ ] ] ] ] [ [ [ [ ] ] ] ] ] ] ] ] [ [ [ [ ] ] ] ] Other items: Pension/retirement fund/profit sharing/ stock plan/401K: Motor vehicles: Make Model VIN Lien Holder [ ] [ ] [ ] [ ] Make Model VIN Lien Holder 5b. ] ] ] ] ] ] ] ] ] ] [ [ [ [ [ ] [ [ [ [ [ [ [ [ [ [ [ [ [ [ [ ] ] ] ] ] ] ] ] ] ] ] [ ] [ ] PROPERTY ACQUIRED BEFORE MARRIAGE (Separate Property) (Check all boxes that apply.) [ ] I do not have any property that I brought into the marriage. [ ] My spouse does not have any property that he or she brought into the marriage. Superior Court of Arizona in Yavapai County Septmeber 2007 Page 3 of 11 American LegalNet, Inc. www.FormsWorkflow.com [ ] I have property that I brought into the marriage. I want this property awarded to me as described it below. [ ] My spouse has property that he or she brought into the marriage. I want this property awarded to my spouse as described below. Separate Property: (List the property and the value of the property, and check the box to tell the Court who should get the property.) DESCRIPTION OF PROPERTY/ VALUE OF PROPERTY HUSBAND [ [ [ [ 6a. ] ] ] ] WIFE [ [ [ [ ] ] ] ] DEBTS INCURRED DURING THE MARRIAGE: [ ] My spouse and I did not incur any community debts during the marriage. Go on to 6b. [ ] We should divide the responsibility for the debts incurred during the marriage as follows: DESCRIPTION OF DEBT/ AMOUNT OF DEBT: HUSBAND [ [ [ [ [ [ [ [ [ [ 6b. ] ] ] ] ] ] ] ] ] ] WIFE [ [ [ [ [ [ [ [ [ [ ] ] ] ] ] ] ] ] ] ] SEPARATE DEBTS. (Check all boxes that apply.) [ ] My spouse and I do not have any debts that were incurred prior to the marriage, OR [ ] I have separate debt that I incurred prior to the marriage that should be paid by me as described below: My spouse has separate debt that he or she or incurred prior to the marriage that should be paid by my spouse as described below: [ ] DESCRIPTION OF DEBT/ AMOUNT OF DEBT: WIFE [ ] Superior Court of Arizona in Yavapai County September 2007 HUSBAND [ ] Page 4 of 11 American LegalNet, Inc. www.FormsWorkflow.com [ [ [ [ 7. ] ] ] ] [ [ [ [ ] ] ] ] TAX RETURNS: After the Judge or Commissioner signs the Decree of Legal Separation, we will pay federal and state taxes as follows: [ ] [ ] For previous calendar years, both parties will pay and hold the other harmless from 2 of all additional income taxes if any and other costs, and each will share equally in any refunds. [ ] 8. For previous years (the years we were married, not including the year the Decree was signed), the parties will file joint federal and state income tax returns. For the calendar year (the year that the Decree is signed) and all future calendar years, each party will file separate federal and state income tax returns. Each party will give the other party all necessary documentation to do so. SPOUSAL MAINTENANCE (ALIMONY) (check the box that applies to you): [ ] Neither party is entitled to Spousal Maintenance (alimony), OR [ ] Petitioner OR [ ] Respondent is entitled to Spousal Maintenance because: (Check one or more of the box(es) below that apply. At least one reason must apply to get spousal maintenance.) [ ] [ ] [ ] Person lacks sufficient property to provide for his or her reasonable needs; Person is unable to support himself or herself through appropriate employment; Person is the custodian of a child(ren) whose age or condition is such that the person should not be required to seek employment outside the home; [ ] Person lacks earning ability in the labor market adequate to support himself or herself; [ ] Person contributed to the educational opportunities of the other spouse or had a marriage of long duration and is now of an age that precludes the possibility of gaining employment adequate to support himself or herself. AND [ ] Spousal maintenance shall be modifiable in accordance with Arizona law, OR [ ] The parties acknowledge that the circumstances of their futures are unknown, but each desires that this maintenance award not be modifiable in the future for any reason. Therefore, it is ordered at this time that this spousal maintenance award shall not be modifiable for any reason. Superior Court of Arizona in Yavapai County September 2007 Page 5 of 11 American LegalNet, Inc. www.FormsWorkflow.com 9. CHILD(REN) OF THE PARTIES WHO ARE LESS THAN 18 YEARS OLD The following child(ren) are under age 18 and were born during the marriage or adopted by me and my spouse: (Attach extra pages if necessary). Child’s Name Birth date Address Length of time at address Names and addresses of persons lived with for the past five (5) years Present addresses of person(s) lived with [ ] The [ ] Petitioner parent OR [ ] Respondent is not the biological or adoptive Child’s Name Birth date Address Length of time at address: Names and addresses of persons lived with for the past five (5) years Present addresses of person(s) lived with [ ] The [ ] Petitioner parent OR [ ] Respondent is not the biological or adoptive Child’s Name Birth date Address Length of time at address: Names and addresses of persons lived with for the past five (5) years Present addresses of person(s) lived with [ ] The [ ] Petitioner parent OR [ ] Respondent is not the biological or adoptive The following child(ren) are under age 18 and were born prior to the marriage and are common to me and my spouse: (Attach extra pages if necessary). Child’s Name Superior Court of Arizona in Yavapai County Septmeber 2007 Page 6 of 11 American LegalNet, Inc. www.FormsWorkflow.com Birth date Address Length of time at address: Names and addresses of persons lived with for the past five (5) years Present addresses of person(s) lived with 10. CUSTODY OR PARENTING TIME CASES INVOLVING THE MINOR CHILD(REN): [ ] I HAVE [ ] I HAVE NOT been a party or a witness in court, in this state or any other state, involving the custody or parenting time of any child(ren) named above. (If so, explain below, using extra pages if necessary.) Name of child: Court state Court location Court case number Status How the child is involved: Summary of any court order: 11. PENDING/PAST CASES RELATED TO MINOR CHILD(REN): (check one box) [ ] I DO [ ] I DO NOT know of any court case, in this state or any other state, that could affect this case, including enforcement, domestic violence, protective orders, drugs, sex offenses, termination of parental rights and adoptions. (If so, explain below, using extra pages if necessary. Court state Court case number Nature of the proceeding: Date of Conviction 12. Court location Status CUSTODY OR PARENTING TIME CLAIMS OF ANY OTHER PERSON: (Check one box) [ ] I KNOW [ ] I DO NOT KNOW the name and address of any person, other than the Petitioner or the Respondent, who has physical custody of the child(ren) or claims rights of legal custody, physical custody or parenting time of any child(ren) named above. (If so, explain below, using extra pages if necessary.) Name of each child: Name of person with the claim: Address of person with the claim: Nature of the claim: 13. PREGNANCY AND PATERNITY [ ] Wife is not pregnant OR Superior Court of Arizona in Yavapai County Septmeber 2007 Page 7 of 11 American LegalNet, Inc. www.FormsWorkflow.com [ ] Wife is pregnant: Due date AND, [ ] [ ] Petitioner is not the parent of the child OR [ ] [ ] 14. The Petitioner and Respondent are the parents of the child OR Respondent is not the parent of the child. A child or children was/were born before the marriage. The husband is the father of that child/those children named below: WRITTEN AGREEMENTS. CHECK ONLY IF TRUE: [ ] [ ] [ ] 15. For our child(ren), my spouse and I have a written agreement signed by both of us about: [ ] Custody; [ ] Parenting time; [ ] Child support. My spouse and I have a written agreement unrelated to the child(ren) and signed by both of us about I am filing the ORIGINAL Agreement. [ ] The Attorney General's office is involved in this case (TANF, IV-D, etc.) OTHER STATEMENTS TO THE COURT UNDER OATH: You must tell the Court the truth. Lying to the Court is a crime and the Court can punish you for lying. To file for legal separation, you must be able to tell the Court that the following statements are true. If the statements are not true, you cannot file for legal separation until the statements are true. Check the box in front of each statement if the statement is true. STATUS OF MARRIAGE AND CONCILIATION: [ ] TRUE: The conciliation requirements under Arizona law, A.R.S. 25-381.09 either do not apply or have been met. [ ] TRUE: This Court has jurisdiction to decide child custody matters under Arizona law. REQUESTS TO THE COURT: A. LEGAL SEPARATION: [ ] B. Decree a Legal Separation; SPOUSAL MAINTENANCE (ALIMONY): [ ] Neither party shall pay spousal maintenance (alimony) to the other party, OR [ ] Petitioner OR [ ] Respondent is ordered to pay the other party the sum of $ per month spousal maintenance BEGINNING AFTER THE Decree is signed. Each payment shall be made by the first day of each month thereafter and shall continue until [ ] the receiving party is remarried or deceased OR Superior Court of Arizona in Yavapai County September 2007 Page 8 of 11 American LegalNet, Inc. www.FormsWorkflow.com [ ] until (date) . All payments shall be made through the Clerk of the Court by automatic wage assignment until all required payments have been made under the Decree. Payments made shall be included in receiving spouse's taxable income and are tax deductible from the paying spouse's income as required by law. [ ] In accordance with the parties' agreements: [ ] The spousal maintenance award shall be modifiable in accordance with Arizona law, OR [ ] The spousal maintenance award shall NOT be modifiable for any reason. C. COMMUNITY PROPERTY: [ ] D. COMMUNITY DEBTS: [ ] E. Order each party to pay community debts as requested in the Petition, and to pay any other community debts unknown to the other party. Order each party to pay and hold the other party harmless from debts incurred by him or her since the parties separation on . SEPARATE PROPERTY: [ ] F. Make a fair division of all community property as requested in this Petition. Award each party his or her separate property. PATERNITY: Declare the husband to be the father of the following named child(ren) born before the marriage and (optional) change the legal name of those children to the name listed below: Current legal name G. Change legal name to: CHILD CUSTODY AND VISITATION: [ ] SOLE CUSTODY: Sole custody of the minor child(ren) awarded to [ ] Petitioner or [ ] Respondent subject to parenting time for the noncustodial parent as follows: 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. These facts support my claim: [ ] Name of person who will supervise Superior Court of Arizona in Yavapai County September 2007 Page 9 of 11 American LegalNet, Inc. www.FormsWorkflow.com [ ] 4. The cost of supervised parenting time shall be paid by OR [ ] Respondent OR [ ] shared equally. [ ] Petitioner [ ] 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. These facts support my claim: OR [ ] JOINT CUSTODY: Petitioner and Respondent agree to act as joint custodians of the minor child(ren) as set forth in the Joint Custody Agreement. (A Joint Custody Agreement signed by both parents must be attached) AND [ ] OR Domestic violence has not occurred during this relationship; [ ] Domestic violence has not been significant. However, domestic violence has occurred as described in the Petition for Order of Protection(s) filed or as described below: OR [ ] Joint custody is in the best interest of the child(ren) even though domestic violence has occurred because Furthermore, the [ ] Petitioner AND/OR [ ] Respondent has/have taken classes, participated in counseling or taken steps to avoid further domestic violence as described below: H. CHILD SUPPORT: Support payments will begin following the entry of the Decree. These payments, and a fee for handling, will be paid through the Clerk of the Court/Clearinghouse and collected by automatic wage assignment. [ ] a [ ] Order that child support shall be paid by [ ] Petitioner OR [ ] Respondent in reasonable amount as determined by the Court under the Arizona Child Support Guidelines and according to the Parent’s Worksheet, which shall be filed with this Petition. OR Order that child support be paid in an amount that deviates from the Guidelines because: [ ] Application of the Guidelines is inappropriate or unjust because [ ] The parties have signed a written agreement free of duress and coercion with Superior Court of Arizona in Yavapai County September 2007 Page 10 of 11 American LegalNet, Inc. www.FormsWorkflow.com knowledge of the amount of support that would have been ordered by the Guidelines but for the agreement. A copy of the agreement is attached. I. INSURANCE AND HEALTH CARE EXPENSES FOR CHILD(REN): Order that [ ] Petitioner [ ] Respondent pay for the health, medical, and dental insurance coverage for the minor child(ren) common to the parties. Petitioner and Respondent will pay for all reasonable unreimbursed medical, dental, and health-related expenses incurred for the child(ren) in proportion to their respective incomes as described in the Parents' Worksheet. J. TAX EXEMPTION: The parties will claim the child(ren) as income tax dependency exemptions on federal and state income tax returns and as allowed by federal and state tax laws as follows: Parent entitled to claim [ [ [ [ K. ] Mother ] Mother ] Mother ] Mother [ [ [ [ Name of child Current tax year Later tax years ] Father ] Father ] Father ] Father OTHER ORDERS I AM REQUESTING (Explain request here): OATH AND VERIFICATION STATE OF County of ) ) ss I, the Petitioner, being duly sworn and under oath, state that I have read this Petition. All the statements in the Petition are true, correct, and complete to the best of my knowledge and belief. Signature SUBSCRIBED AND SWORN to before me this by , 20 __ . My Commission Expires: day of Notary Public Superior Court of Arizona in Yavapai County September 2007 Page 11 of 11 American LegalNet, Inc. www.FormsWorkflow.com