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Petition To Establish Non-Parent Custody Form. This is a Arizona form and can be use in Yavapai Local County.
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Tags: Petition To Establish Non-Parent Custody, DRNPEC11f, Arizona Local County, Yavapai
Name:
Mailing Address:
Daytime Telephone:
Representing Self, Without a Lawyer
IN THE SUPERIOR COURT OF ARIZONA, YAVAPAI COUNTY
Regarding the matter of the custody of
Minor Child(ren)
Mother
Father
Applicant
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DO _______________________
PETITION TO ESTABLISH
NON-PARENT CUSTODY
[656]
STATEMENTS TO THE COURT, UNDER OATH
1.
INFORMATION ABOUT ME, THE APPLICANT
Name:
Date of Birth
Address
Occupation:
My relationship to the child(ren) for whom I
want the court order:
The Applicant is enlisted in the military, and
has
deployed for at least one day during the past 6 months.
2.
INFORMATION ABOUT THE MOTHER
OR
has not
been
Deceased
Name:
Date of Birth
Address
Occupation:
My relationship to the child(ren) for whom
I want the court order:
The Mother is enlisted in the military, and
has
OR
has not
been
deployed for at least one day during the past 6 months.
Superior Court of Arizona in Yavapai County
September 2007
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DRNPEC11f
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3.
INFORMATION ABOUT THE FATHER
Deceased
Name:
Date of Birth
Address
Occupation:
My relationship to the child(ren) for whom I
want the court order:
The Father is enlisted in the military, and
has OR
deployed for at least one day during the past 6 months.
4.
has not
been
INFORMATION ABOUT THE CHILD(REN) OF WHOM I AM SEEKING CUSTODY:
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
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.
INFORMATION ABOUT CUSTODY OF THE CHILD(REN): (check one box)
Mother has had physical custody of the child(ren) for the last 6 months.
Superior Court of Arizona in Yavapai County
September 2007
Page 2 of 6
DRNPEC11f
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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
Hearing date set on (date)
Location/address:
Other (explain in detail):
6.
at (time)
.
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
How the child is involved:
Summary of any court order:
7.
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).
Court state
Court case number
How the child is involved:
Summary of any court order:
Date of conviction
8.
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 legal
parents or the Applicant, who has physical custody of the child(ren) or claims rights of legal custody,
Superior Court of Arizona in Yavapai County
September 2007
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DRNPEC11f
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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:
OTHER STATEMENTS, UNDER OATH, TO THE COURT:
8.
I believe I stand in loco parentis to the child(ren) because:
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9.
It would be significantly detrimental to the child(ren) to remain or be placed in the custody of either of
the child(ren)'s living legal parents who wish to retain or obtain custody for the following reason(s):
10.
11.
I have filed on (date)
to Establish Child Support.
, or am filing with this Petition, a Petition
JURISDICTION.
A court of competent jurisdiction has not entered or approved an order concerning the
child(ren)'s custody within one year before I file this Petition.
OR
A custody order has been entered within the past year, but I believe the child(ren)'s present
environment may seriously endanger the child(ren)'s physical, mental, emotional or moral
health for the following reason(s):
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
12.
REQUIREMENTS TO BRING ACTION.
A.
The child(ren)'s
Mother
Father is deceased.
B.
The parents were not married to each other at the time of the child(ren)'s birth(s)
AND
has been legally established as the
father of the child(ren)
C.
The child(ren)'s legal parents are not married to each other at the time I file this
Petition.
Superior Court of Arizona in Yavapai County
September 2007
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DRNPEC11f
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D.
13.
There is a pending proceeding for dissolution of marriage or for legal separation of the
legal parents at the time I file this Petition in:
Name and location of court
VENUE: This is the proper court to bring this lawsuit under Arizona law because it is the county of
residence of the child(ren) or other
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I RESPECTFULLY REQUEST THE COURT TO:
1.
Award SOLE CUSTODY of the minor child(ren) to (applicant)_
subject to parenting time as follows:
A.
,
Mother be awarded:
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:
5.
B.
Does not apply.
Father be awarded:
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
Superior Court of Arizona in Yavapai County
September 2007
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DRNPEC11f
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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:
5.
Does not apply.
2.
Other
3.
Any other relief the Court deems appropriate for non-parent custody.
OATH AND VERIFICATION
State of Arizona
County of Yavapai
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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
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