Download Free Print-Only PDF OR Purchase Interactive PDF Version of this Form
Petition To Establish Custody-Parenting Time Form. This is a Arizona form and can be use in Yavapai Local County.
Loading PDF...
Tags: Petition To Establish Custody-Parenting Time, DRCV11f, Arizona Local County, Yavapai
(1) Person Filing:
Mailing Address:
City, State, Zip Code:
Daytime / Evening Phone:
Person Filing Document is:
(If Attorney) State Bar No.:
Attorney Phone:
ATLAS No. (if applicable):
Self or Attorney for
/
Plaintiff
Respondent
SUPERIOR COURT OF ARIZONA IN YAVAPAI COUNTY
Regarding the Matter of:
Case No.:
Petitioner
(Check one box only)
PETITION TO ESTABLISH
CHILD CUSTODY, PARENTING TIME,
and CHILD SUPPORT
Respondent
CHILD CUSTODY AND PARENTING
TIME (ONLY)
General Information:
1.
INFORMATION ABOUT THE PETITIONER
Name:
Address:
County of residence:
Date of Birth:
Occupation:
Relationship to children for whom I want the CUSTODY/PARENTING TIME order:
Mother
Father
Other: (explain)
2.
INFORMATION ABOUT THE RESPONDENT
Name:
Address:
County of residence:
Date of Birth:
Occupation:
Relationship to children for whom I want the CUSTODY/PARENTING TIME order:
Mother
Father
Other: (explain)
Superior Court of Arizona in Yavapai County
August 2010
Page 1 of 5
DRCV11f
American LegalNet, Inc.
www.FormsWorkFlow.com
Case No.
3.
JURISDICTION: WHY I AM FILING THIS COURT CASE IN ARIZONA AGAINST THE OTHER
PERSON: (check all that apply)
The person is a resident of Arizona.
I believe that I will personally serve the person in Arizona (see “Service” packet for information).
The person agrees to have the case heard here and will file written papers in the court case.
The person lived with the minor child(ren) in this state at some time.
The person lived in this state and provided pre-birth expenses or support for the minor child(ren).
The minor child(ren) lives in this state as a result of the acts or directions of the person.
The person had sexual intercourse in this state as a result of which the minor child may have been
conceived in Arizona.
The person signed an acknowledgment of paternity that is filed in this state.
The person did any other acts that substantially connect the person with this state (see a lawyer to
help you determine this).
4.
INFORMATION ABOUT MINOR CHILD(REN) FOR WHOM I WANT CUSTODY/PARENTING TIME
ORDER:
Name:
Birthdate:
Current Address:
Name:
Birthdate:
Current Address:
County of residence:
Father:
Mother:
County of residence:
Father:
Mother:
Name:
Birthdate:
Current Address:
Name:
Birthdate:
Current Address:
County of residence:
Father:
Mother:
County of residence:
Father:
Mother:
STATEMENTS ABOUT PATERNITY AND CHILD SUPPORT:
5.
PATERNITY WAS ESTABLISHED BY: (check one box).
(A copy of any Order or document referenced here should already be in the Court file or attached.)
A Court Order for Paternity from this county or previously transferred to this county stating that
is the natural father of the minor child(ren). (A.R.S. § 25-502(c))
Both parents signing an Acknowledgment of Paternity through the Hospital Paternity Program
or other means provided by law after July 18, 1996, and a birth certificate listing the name of the father was
issued as a result.
We do not have an order of paternity, but we do have a child support order. (See instructions)
Parties were legally married when minor child(ren) was (were) born, conceived or adopted.*
*NOTE: If married when minor child(ren) born, conceived or adopted, and no decree of Divorce or
Separation has been issued, STOP! Do not use these forms unless advised to do so by an attorney.
Requests for custody and parenting time must generally be filed as part of a case for Separation or
Divorce.
Superior Court of Arizona in Yavapai County
August 2010
Page 2 of 5
DRCV11f
American LegalNet, Inc.
www.FormsWorkFlow.com
6.
Case No.
INFORMATION ABOUT CHILD SUPPORT FOR MINOR CHILDREN: (check one box)
An Order for Child Support is dated
from (name of court)
which states that child support is established and does not need to be changed. Note: if order is
from court other than Superior court in Yavapai County, see instructions)
An Order for Child Support is dated
from (name of court)
which states that child support is established and does need to be changed. Note: if order is
from court other than Superior Court in Yavapai County, see instructions)
To my knowledge there is no child support order for the minor child(ren) and the court should
order child support in this case along with custody and parenting time.
Other information about the minor children:
7.
WHERE THE CHILDREN WHO ARE UNDER 18 YEARS OLD HAVE LIVED FOR THE LAST 5 YEARS.
(Attach extra pages if necessary.)
Child's Name
Lived with
Street address
To
Child's Name
Lived with
Street address
Dates: From
Relationship to child:
City, State:
To
Child's Name
Lived with
Street address
8.
Dates: From
Relationship to child:
City, State:
Dates: From
Relationship to child:
City, State:
To
COURT CASES NOT INVOLVING CUSTODY OR PARENTING TIME RELATED TO THE CHILDREN
I HAVE
I HAVE NOT been a party or a witness in court
UNDER 18 YEARS OLD: (check one box)
in this state or any other state regarding the custody or parenting time of any of the minor children named
above (If so, explain below, using extra pages if necessary. IF NOT, GO ON.)
Name of each child:
Court state
Court case number
How the minor child(ren) is (are) involved:
Court location
Current status
Summary of any Court Order:
9.
CUSTODY OR PARENTING TIME CASES RELATED TO CHILDREN UNDER 18 YEARS OLD:
(check one box)
I DO NOT HAVE
I DO HAVE information about a custody or parenting time court case relating to
any of the minor children named above that is pending in this state or in any other state (If so, explain
below, using extra pages if necessary. IF NOT, GO ON).
Name of each child:
Court state
Court case number
Nature of the court proceeding:
Summary of Court order:
Superior Court of Arizona in Yavapai County
August 2010
Court location
Current status
Page 3 of 5
DRCV11f
American LegalNet, Inc.
www.FormsWorkFlow.com
10.
Case No.
CUSTODY OR PARENTING TIME CLAIMS OF ANY PERSON:
(check one box)
I DO NOT KNOW
I DO KNOW a person other than the Petitioner or the Respondent who has
physical custody or who claims custody or parenting time rights to any of the minor children named above.
(If so, explain below, using extra pages if necessary. IF NOT, GO ON).
Name of each child:
Name of person with the claim:
Address of person with the claim:
Nature of the claim:
OTHER STATEMENTS TO THE COURT:
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.
DOMESTIC VIOLENCE: (check if you are asking for joint custody; this statement must be true about
you)
Domestic violence has not occurred between the parties.
13.
VENUE: This is the proper court to bring this lawsuit under Arizona law because
residence of the petitioner, or the respondent, or the minor child(ren).
14.
The Parent Education Program (PEP) is required for persons seeking custody or parenting time.
I have
I have not (check one box) already completed the Parenting Education Program.
it is the county of
REQUESTS I MAKE TO THE COURT IN THIS LAWSUIT:
1.
CUSTODY OF MINOR CHILDREN: (check and complete A or B) Order that:
a. SOLE CUSTODY:
Sole custody of the minor child(ren) awarded to
subject to parenting time as follows:
me or
the other party
1.
Reasonable parenting time rights to the parent not having custody, as will be described in a
Parenting Plan attached to the Final Order.
2.
Check and explain ONLY if you want the other parent to have Supervised Parenting time
OR NO Parenting time):
Supervised Parenting time between the children and
me OR
the other party; OR
NO Parenting time between the children and
me OR
the other party is in the best
interests of the children, pursuant to A.R.S. Sections 25-337 and 25-338, because (explain here
reasons for supervision or no parenting time):
3.
Supervised parent/child access to the parent not having custody, only in the presence of
another person, who is named by the court (suggestion below) upon a finding that supervised
access is in the best interest of the minor child.
Person to supervise:
Requested restrictions on parenting time: (explain here)
Superior Court of Arizona in Yavapai County
August 2010
Page 4 of 5
DRCV11f
American LegalNet, Inc.
www.FormsWorkFlow.com
Case No.
The cost of supervised parent/child access shall be paid by:
the parent being supervised;
the parent having custody;
shared equally by the parties.
4.
1.
No Parenting time rights to the parent not having custody, OR:
b. JOINT CUSTODY:
Joint Custody - Petitioner and Respondent agree to act as joint custodians of the
minor children, as set forth in the Joint Custody Agreement by the parties pursuant to A.R.S. Section 25403, signed by both parties, if the Court adopts the agreed terms of the Joint Custody Agreement setting
forth the custody and parenting time agreement between the parties. There have been no significant acts
of Domestic Violence under A.R.S.13-3601 by either parent.
Check below if you are asking for a child support order or a change of child support in this case:
2.
CHILD SUPPORT: Order that child support shall be paid by: (check one box)
me or other party in a reasonable amount as determined by the court under the Arizona
Child Support Guidelines (Child Support Order to be attached to the Custody/parenting time
Order). Support payments shall begin on the first day of the first month following the entry of the
Custody/ Parenting time order. These payments, plus a fee for handling, shall be paid through the
Clerk of the Court and collected by automatic wage assignment.
3.
MEDICAL, DENTAL, VISION CARE
Mother should be responsible for providing:
Father should be responsible for providing:
medical
medical
dental
dental
vision care insurance.
vision care insurance.
Medical, dental, and vision care insurance, payments and expenses are based on the information in the
Parent’s Worksheet for Child Support attached and incorporated by reference. The party ordered to pay must
keep the other party informed of the insurance company name, address and telephone number, and must give
the other party the documents necessary to submit insurance claims.
%, AND Respondent is ordered to pay
Non-Covered Expenses. Petitioner is ordered to pay
% of all reasonable uncovered and/or uninsured medical, dental, vision care, prescription and
other health care charges for the minor child(ren), including co-payments.
4.
OTHER ORDERS I AM REQUESTING (explain request here):
DECLARATION UNDER PENALTY OF PERJURY
I declare that the contents of this document are true and correct under penalty of perjury.
Signature
Date
Printed Name
Superior Court of Arizona in Yavapai County
August 2010
Page 5 of 5
DRCV11f
American LegalNet, Inc.
www.FormsWorkFlow.com
