Name: Mailing Address: Daytime Telephone Representing Self, Without a Lawyer IN THE SUPERIOR COURT OF ARIZONA, YAVAPAI COUNTY Regarding the matter of DO ATLAS #: Petitioner vs. PETITION FOR ORDERS OF PATERNITY, CUSTODY, PARENTING TIME AND CHILD SUPPORT Respondent STATEMENTS TO THE COURT, UNDER OATH 1. INFORMATION ABOUT ME, THE PETITIONER Name: Date of Birth Address: Occupation: My relationship to the child(ren) for whom I request orders of Paternity, Custody, Parenting Time and Child Support: [ ] Mother [ ] I claim to be the Father [ ] I am a Court-appointed guardian, conservator or “best friend” of the child(ren) who were born out of wedlock. [ ] The Petitioner is enlisted in the military, and [ ] has OR [ ] has not been deployed for at least one day during the past 6 months. 2. INFORMATION ABOUT THE RESPONDENT Name: Date of Birth Address: Occupation: Respondent’s relationship to the child(ren) for whom I request orders of Paternity, Custody, Parenting Time and Child Support: [ ] Mother [ ] He claims to be the Father [ ] The Respondent is enlisted in the military, and Superior Court of Arizona in Yavapai County July 2010 Page 1 of 7 [ ] has OR [ ] has not been DRP11f American LegalNet, Inc. www.FormsWorkFlow.com deployed for at least one day during the past 6 months. 3. WHY I AM FILING THIS COURT CASE AGAINST THE RESPONDENT IN ARIZONA: (Check one or more boxes that are true.) [ ] The Respondent is a resident of Arizona [ ] [ ] [ [ [ [ ] ] ] ] [ ] 4. I will personally serve the Respondent in Arizona (see packet on service to learn how to do this.) The Respondent agrees to have the case heard here and will file written papers in the case. The Respondent lived with the child(ren) in Arizona at some time. The Respondent lived in Arizona and provided pre-birth expenses or support for the child(ren). The child lives in Arizona as a result of the acts or directions of the Respondent. The Respondent had sexual intercourse in Arizona as a result of which the child(ren) may have been conceived. The Respondent did any other acts that substantially connect the Respondent with Arizona (see a lawyer to help you determine this). INFORMATION ABOUT THE CHILD(REN) FOR WHOM I REQUEST ORDERS: 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 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 5. 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.) Superior Court of Arizona in Yavapai County July 2010 Page 2 of 7 DRP11f American LegalNet, Inc. www.FormsWorkFlow.com Name of child: Court state Court case number How the child is involved: Summary of any court order: 6. Court location Status 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, sexual 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: 7. 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: STATEMENTS ABOUT PATERNITY: 8. WHY I THINK IS THE FATHER OF THE CHILD(REN): Name of purported father (Check which box applies. More choices on next page.) [ ] AFFIDAVIT: Petitioner and Respondent signed an Affidavit of Paternity acknowledging that [ ] Petitioner [ ] Respondent is the child(ren)'s natural father. A certified copy is attached to this Petition. [ ] BLOOD TEST: The parties had DNA (Deoxyribonucleic Acid) Testing administered and is shown to be the minor child(ren)'s natural father. A copy of the report is attached to this Petition. [ ] PARTIES LIVING TOGETHER: Petitioner and Respondent were not married to each other at any time during the ten months before birth of the child(ren). However, the parties lived together during the period(s) when the child(ren) could have been conceived. [ ] SEXUAL INTERCOURSE: Petitioner and Respondent were not living together but had sexual intercourse at the probable date of conception of the child(ren). The mother of the child(ren) did not have sexual intercourse with anyone else during the period in which the Superior Court of Arizona in Yavapai County July 2010 Page 3 of 7 DRP11f American LegalNet, Inc. www.FormsWorkFlow.com [ ] 9. child(ren) could have been conceived. OTHER (explain) ABOUT MARRIAGE AND HUSBAND -- check one box. [ ] Mother was not married at time child(ren) were born or conceived or at least 10 months before child(ren) were born or conceived, OR [ ] Mother was married when chiLd(ren) were born or conceived or at least 10 months before child(ren) were born or conceived, but husband is not father of child(ren). Husband is a party to this court case because of marriage. OTHER STATEMENTS TO THE COURT: 10. MEDICAL EXPENSES: [ ] THERE ARE [ ] THERE ARE NOT unreimbursed medical expenses incurred by the mother, resulting from the birth of the minor child(ren). If there are, these costs and expenses should be awarded to [ ] PETITIONER [ ] RESPONDENT according to A.R.S. § 25320. 11. OTHER EXPENSES: The parties should be ordered to divide between them any uninsured medical, dental, or health expenses, reasonably incurred for the minor child(ren), in proportion to their respective incomes. 12. [ ] 13. WRITTEN AGREEMENTS. CHECK ONLY IF TRUE: The Attorney General's office is involved in this case (TANF, IV-D, etc.). [ ] 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 not related to the child(ren) and signed by both of us about I am filing the ORIGINAL Agreement. [ ] 14. VENUE: This is the proper court to bring this lawsuit under Arizona law because it is the county of residence of the Petitioner or the Respondent or the child(ren). REQUESTS I MAKE TO THE COURT IN THIS CASE: 1. PATERNITY: Order that ________________________________________ is the natural father of the minor children; Name of purported Father 2. BIRTH CERTIFICATE: (Mark the box and complete if you want this) [ ] Order that certificate; name be added to each child's birth Name of purported Father Superior Court of Arizona in Yavapai County July 2010 Page 4 of 7 DRP11f American LegalNet, Inc. www.FormsWorkFlow.com 3. LAST NAME: (Mark the box and complete if you want this) [ ] Order that each child's last name be changed to 4. ; CUSTODY OF CHILD(REN): [ ] 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: [ ] [ ] 4. Name of person who will supervise The cost of supervised parenting time shall be paid by OR [ ] Respondent OR [ ] shared equally. [ ] 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: [ ] Petitioner 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 Superior Court of Arizona in Yavapai County July 2010 Page 5 of 7 DRP11f American LegalNet, Inc. www.FormsWorkFlow.com Furthermore, the [ ] Petitioner AND/OR [ ] Respondent has/have taken classes, participated in counseling or taken steps to avoid further domestic violence as described below: 5. CHILD SUPPORT: Support payments will begin following the entry of the Order. These payments, and a fee for handling, will be paid through the Clerk of the Court/Clearinghouse and collected by automatic wage assignment. [ ] [ ] Order that child support shall be paid by [ ] Petitioner OR [ ] Respondent in a 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 [ ] [ ] 6. The parties have signed a written agreement free of duress and coercion with 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. Order that costs for past child support for child(ren) in the amount of $ paid by [ ] PETITIONER [ ] RESPONDENT at the rate of $ paid in full. Payments shall be made as stated above. shall be per month until EXPENSES OF MOTHER: Order that [ ] PETITIONER OR [ ] RESPONDENT pay a reasonable amount to cover unreimbursed expenses incurred by the mother related to the birth of the child(ren). 7. HEALTH, MEDICAL AND DENTAL INSURANCE AND HEALTH CARE EXPENSES FOR CHILD(REN): Order that [ ] PETITIONER OR [ ] RESPONDENT shall pay for health, medical, dental insurance coverage for the child(ren) under the age of 18 years, and that the Petitioner and Respondent shall pay for all reasonable unreimbursed medical, dental, heath-related expenses incurred for the child(ren) in proportion to their respective incomes as described on the Parents' Worksheet for Child Support Amount. 8. TESTING and COSTS: Order that if paternity is contested, Petitioner and Respondent be ordered to submit to such blood and tissue tests as may be deemed necessary by this Court to establish paternity, AND that Respondent must pay all costs and expenses of this lawsuit under Arizona law, if he/she contests these proceedings and the Court rules in favor of Petitioner, including the costs of the blood tests or other genetic testing; filing each child's birth certificate; attorney's fees and court costs. Superior Court of Arizona in Yavapai County July 2010 Page 6 of 7 DRP11f American LegalNet, Inc. www.FormsWorkFlow.com 9. OTHER ORDERS I AM REQUESTING (explain request here): OATH AND VERIFICATION OF PETITIONER STATE OF ARIZONA County of ) ) 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. SIGNED: SUBSCRIBED AND SWORN to before me this day of , 20____, by the . Petitioner, My Commission Expires: Notary Public Superior Court of Arizona in Yavapai County July 2010 Page 7 of 7 DRP11f American LegalNet, Inc. www.FormsWorkFlow.com