Name: Mailing Address Daytime Telephone Representing Self, Without a Lawyer IN THE SUPERIOR COURT OF ARIZONA, YAVAPAI COUNTY Regarding the matter of DO PETITION TO ESTABLISH Petitioner vs. Custody Parenting Time Respondent STATEMENTS TO THE COURT UNDER OATH: 1. INFORMATION ABOUT THE PETITIONER Name: Date of Birth Address: Occupation: The Petitioner is the Mother Father Other of the child(ren): The Petitioner is enlisted in the military, and has deployed for at least one day during the past 6 months. 2. OR has not been INFORMATION ABOUT THE RESPONDENT Name: Date of Birth Address: Occupation: The Respondent is the Mother Father Other The Respondent is enlisted in the military, and has deployed for at least one day during the past 6 months. 3. of the child(ren): OR has not been INFORMATION ABOUT CHILD(REN) UNDER THE AGE OF 18: (Add 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 Superior Court of Arizona in Yavapai County September 2007 Page 1 of 5 DRECV11f Use only most current version American LegalNet, Inc. www.FormsWorkflow.com 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 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 4b. 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 case number How the child is involved: Summary of any court order: 4c. 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, drug convictions, sexual offenses, termination of parental rights and adoptions. (If so, explain below, using extra pages if necessary). Superior Court of Arizona in Yavapai County September 2007 Page 2 of 5 DRECV11f Use only most current version American LegalNet, Inc. www.FormsWorkflow.com Court state Court case number Nature of the proceeding: Date of conviction 4d. 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 PARENTAGE, CUSTODY AND CHILD SUPPORT: 5. INFORMATION ABOUT PARENTAGE OF THE CHILD(REN): (check one box) An Order for Paternity, dated and issued in the following court, , states that is the natural father of the child(ren). A copy of the Order is already in this court file or is being filed along with this Petition. A Decree of Dissolution or Legal Separation , dated and issued in the following court , names the Petitioner and Respondent as the legal parents of the child(ren). A copy of the Decree is already in this court file or is being filed along with this Response. 6. INFORMATION ABOUT CUSTODY OF THE CHILD(REN): (check one box) Mother has had physical custody of the child(ren) for the last 6 months. Father has had physical custody of the child(ren) for the last 6 months. A person other than mother or father has had physical custody of the child(ren) for the last 6 months, because of a court case or government agency, and there is no disagreement between the parents and the party(ies) who have physical custody. (Describe court case on next page.) Names of party(ies) with custody: Name of court or government agency: Type of case: Date of order of custody (if any): What order said: Court or government agency case number Location of court or government agency (city and state): Status of case now Final Order entered; case is over Superior Court of Arizona in Yavapai County September 2007 Page 3 of 5 DRECV11f Use only most current version American LegalNet, Inc. www.FormsWorkflow.com Hearing date set on (date) Location/address: Other (explain in detail): 7. at (time) . INFORMATION ABOUT CHILD SUPPORT FOR THE CHILD(REN): There is an Order for Child Support, dated and issued in the following court , covering the child(ren). There is currently no order for child support, but a Petition to Establish Child Support has been filed in this case, or will be filed with this Petition. 8. 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 OTHER STATEMENTS TO THE COURT: 9. 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 TO THE COURT: 1. Award CHILD CUSTODY AND PARENTING TIME as follows: 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 The cost of supervised parenting time shall be paid by OR Respondent OR shared equally. 4. 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: Superior Court of Arizona in Yavapai County September 2007 Page 4 of 5 DRECV11f Use only most current version American LegalNet, Inc. www.FormsWorkflow.com OR JOINT CUSTODY: Petitioner and Respondent agree to act as joint custodians of the minor child(ren) as set forth in the Joint Custody and Parenting Time Plan. (A Joint Custody Agreement signed by both parents must be attached) AND Domestic violence has not occurred during this relationship; OR 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: OTHER ORDERS I AM REQUESTING THE COURT TO MAKE: OATH AND VERIFICATION State of Arizona County of Yavapai ) ) I, , being duly sworn and under oath, state that I have read this Petition and it is true and correct 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 , by day of , 20 My commission expires: Notary Public Superior Court of Arizona in Yavapai County September 2007 Page 5 of 5 DRECV11f Use only most current version American LegalNet, Inc. www.FormsWorkflow.com