(A) Name: Mailing Address: Daytime Telephone: ATLAS#: Representing Self, Without a Lawyer IN THE SUPERIOR COURT OF ARIZONA, YAVAPAI COUNTY Regarding the Matter of: (C) DO (D) (B) Petitioner PETITION FOR [ [ [ [ [ and (B) Respondent ] ] ] ] ] Relocation of Child(ren) Prevent Relocation of Child(ren) Modification of Custody Modification of Parenting Time Clarification of Parenting Time STATEMENTS MADE TO THE COURT, UNDER OATH 1. Petitioner's Name: Address: County of residence: Date of birth The Petitioner is the [ ] Mother [ ] Father [ ] Other: (explain) the child(ren) who is/are the subject(s) of this Petition. [ ] 2. The Petitioner is enlisted in the military, and [ ] has OR [ ] has not been deployed for at least one day during the past 6 months (skip if you are requesting clarification only). Respondent's Name: Address: County of residence: Date of birth The Respondent is the [ ] Mother [ ] Father [ ] Other: (explain) the child(ren) who is/are the subject(s) of this Petition. [ ] 3. of of The Respondent is enlisted in the military, and [ ] has OR [ ] has not been deployed for at least one day during the past 6 months(skip if you are requesting clarification only) . INFORMATION ABOUT THE CHILD(REN) who is/are the subject(s) of this Petition (skip if you are requesting clarification only): 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 Superior Court of Arizona in Yavapai County September 2007 Page 1 of 7 American LegalNet, Inc. www.FormsWorkflow.com 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 4. CUSTODY OR PARENTING TIME CASES INVOLVING THE MINOR CHILD(REN) (skip if you are requesting clarification only): [ ] 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: 5. PENDING/PAST CASES RELATED TO MINOR CHILD(REN) (skip if you are requesting clarification only): (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, drug convictions, sexual offenses, termination of parental rights and adoptions. (If so, explain below, using extra pages if necessary. Court state Court location Court case number Status Nature of the proceeding: Date of conviction, if applicable 6. CUSTODY OR PARENTING TIME CLAIMS OF ANY OTHER PERSON (skip if you are requesting clarification only): (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.) Superior Court of Arizona in Yavapai County September 2007 Page 2 of 7 American LegalNet, Inc. www.FormsWorkflow.com Name of each child: Name of person with the claim: Address of person with the claim: Nature of the claim: 7. RELOCATION (if applicable). Moving party wishes to [ ] relocate with the child(ren) OR [ ] prevent relocation to (location) Date of planned move 8. BASIS OF RELOCATION REQUEST (if applicable). A. [ ] Applicant believes that this relocation is in the best interest(s) of the child(ren) and will substantially improve the quality of life for the Applicant and the child(ren) for the following reasons: OR [ ] Applicant believes that this relocation is not in the best interests of the child(ren) and will adversely affect the child(ren) and/or his or her custody and/or parenting time rights for the following reasons: 1. 2. 3. B. Applicant's motives in seeking to relocate: [ ] are OR [ ] are not interfere with the other party's relationship with the children because C. A realistic substitute parenting time schedule to allow the other party time with the child(ren): [ ] is OR [ ] is not possible as shown in the attached and incorporated Proposed Parenting Plan because D. Other reasons (pursuant to A.R.S. 25-408 and 25-403, et.seq.) 9. [ ] Notice of proposed relocation pursuant to A.R.S. 25-408: [ ] was properly given to: (name) on (date) by (how notice was given) 10. CURRENT CUSTODY/PARENTING TIME ORDERS: [ ] [ ] [ ] was not I have a current custody order by the Superior Court in Yavapai County. Date of order or decree: I have a current custody order from the Superior Court in Arizona but not from Yavapai County. [ ] I have already filed a certified copy with this Court. Name of county Date of order or decree: Superior Court of Arizona in Yavapai County September 2007 OR intended to Page 3 of 7 American LegalNet, Inc. www.FormsWorkflow.com [ ] [ ] 11. I have a current custody order from another state. [ ] I have already filed a certified copy with this Court. I have also listed the prior addresses of the child(ren) for the past five (5) years above. Name of state: Name of county in state: Date of order or decree: This Court has jurisdiction to decide this custody issue pursuant to A.R.S. 25-1034 because the child(ren) is present in the state and is abandoned or an emergency exists such that the child(ren), sibling(s) and/or parent of the child(ren) is in danger of bodily injury. Facts supporting this claim WHAT THE CURRENT ORDER SAYS ABOUT CUSTODY [ ] Sole Custody of the minor child(ren) to [ ] Petitioner [ ] Respondent. [ ] [ ] [ ] I make this request at least one (1) year after the judge signed the custody decree/order. OR Less than one (1) year has passed since the custody decree/order was signed, but I want to change it because I have reason to believe the child(ren)'s present surroundings may endanger the child(ren)'s physical, mental, moral or emotional health. Joint Custody of the minor child(ren) to both Petitioner and Respondent, and [ ] Petitioner [ ] Respondent was given primary care of the child(ren). [ ] [ ] [ ] [ ] I make this request at least one year after the judge signed the custody decree/order. OR I make this request at least six (6) months after the judge signed the decree/order because the other parent has failed to follow the decree/order. OR I make this request less than six (6) months after the judge signed the decree/order for joint custody, but since the judge signed the decree/order for joint custody there has been [ ] Domestic Violence between the parties. Spousal Abuse [ ] Child Abuse has occurred. Name and location of Government Agency or court reported to Date [ ] 12. Case number The current custody order or agreement contains a provision that requires the parties to pursue mediation or other alternative dispute resolution process before requesting a modification order and I have taken the following steps to comply with this provision: WHAT THE CURRENT ORDER SAYS ABOUT PARENTING TIME [ ] Reasonable parenting time to [ ] Petitioner [ ] Respondent [ ] According to the terms of a Parenting Plan filed (date) Pursuant to the Yavapai County Child Access Guidelines [ ] [ ] Supervised parenting time to [ ] Petitioner [ ] Respondent [ ] No parenting time to [ ] Petitioner [ ] Respondent Superior Court of Arizona in Yavapai County September 2007 OR OR OR OR Page 4 of 7 American LegalNet, Inc. www.FormsWorkflow.com [ ] The current parenting time order or agreement contains a provision that requires the parties to pursue mediation or other alternative dispute resolution process before requesting a modification order and I have taken the following steps to comply with this provision: 13. WHAT THE CURRENT ORDER SAYS ABOUT RELOCATION (if applicable): [ ] There is an attached Parenting Plan or other written agreement between the parties that [ ] permits OR [ ] prohibits relocation; OR [ ] Other 14. THIS IS THE PART OF THE ORDER I WANT MODIFIED OR CLARIFIED: (Explain in detail and use extra pages if necessary) [ ] I do not want to change the current [ ] Custody order. AND/OR [ ] Parenting Time 15. WHY THE DECREE/ORDER SHOULD BE CLARIFIED (if applicable): 16. WHAT THE DECREE/ORDER SHOULD BE CLARIFIED TO STATE (if applicable): 17. WHY THE DECREE/ORDER ON CUSTODY AND/OR PARENTING TIME SHOULD BE CHANGED: These are the reasons why I believe that a change of custody and/or parenting time is in the best interest of the child(ren) (Explain in detail and use extra pages if necessary; skip if you are requesting clarification): [ ] [ ] 18. To permit relocation of the child(ren) as explained above. Other TIME FOR HEARING. I estimate the hearing will take [ ] minutes OR [ ] hours REQUESTS I MAKE TO THE COURT: Superior Court of Arizona in Yavapai County September 2007 Page 5 of 7 American LegalNet, Inc. www.FormsWorkflow.com 1. 2. 3. 4. 5. [ [ [ [ [ ] ] ] ] ] Issue an Order that permits relocation of child(ren) named above. Issue an Order that prohibits relocation of the child(ren) named above. Retain current custody and/or parenting plan and dismiss action. Issue an Order clarifying the parenting time arrangement. Modify custody and/or parenting time as indicated below: [ ] 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 [ ] 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 Superior Court of Arizona in Yavapai County September 2007 AND/OR [ ] Respondent has/have taken Page 6 of 7 American LegalNet, Inc. www.FormsWorkflow.com classes, participated in counseling or taken steps to avoid further domestic violence as described below: 6. [ ] CHILD SUPPORT: Support payments shall begin following the entry of the new Custody and/or Parenting Time Order. These payments, plus a fee for handling, shall be paid through the Support Payment Clearinghouse and collected by automatic wage assignment. AND [ ] Order that child support shall be paid 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 [ ] OR 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. HEALTH, MEDICAL, DENTAL INSURANCE AND HEALTH CARE EXPENSES FOR CHILDREN: Order that [ ] Petitioner or [ ] Respondent shall pay for health, medical, dental insurance coverage for the children under the age of 18 years, and that [ ] Petitioner or [ ] Respondent shall pay for all reasonable unreimbursed medical, dental, health-related expenses incurred for the child(ren) in proportion to their respective incomes as described on the Parent’s Worksheet, which shall be filed with this Petition. 7. [ ] 8. OTHER ORDERS I AM REQUESTING (Explain request here and use extra pages if necessary): OATH AND VERIFICATION State of Arizona County of Yavapai ) ) , being duly sworn and under oath, state that I have I, read this Petition and to the best of my knowledge, information and belief. I understand that if the judicial officer finds that I did file this Petition for an improper purpose, contempt or other sanctions may be ordered against me, including assessing me for any and all reasonable costs, attorney fees, or other expenses associated with the improper filing. SIGNED SUSCRIBED AND SWORN to before me this day of , 20 , by My commission expires: Notary Public Superior Court of Arizona in Yavapai County September 2007 Page 7 of 7 American LegalNet, Inc. www.FormsWorkflow.com