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 and RESPONSE TO PETITION FOR ORDERS OF PATERNITY, CUSTODY, PARENTING TIME AND CHILD SUPPORT Respondent STATEMENTS TO THE COURT, UNDER OATH: GENERAL INFORMATION: 1. INFORMATION ABOUT THE PETITIONER Name:_________________________________________ Date of Birth _____________________ Address:_______________________________________________________________________ Occupation:_____________________________________ The Petitioner's relationship to the child(ren) for whom the paternity order is requested: [ ] Mother [ ] He claims to be the Father [ ] Is a Court-appointed guardian, conservator or best friend for 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 ME, THE RESPONDENT Name:_________________________________________ Date of Birth _____________________ Address:_______________________________________________________________________ Occupation:_____________________________________ My relationship to the child(ren) for whom the paternity order is requested: Mother [ ] [ ] I claim to be the Father [ ] I am a Court-appointed guardian, conservator or best friend for the child(ren) who were born out of wedlock Superior Court of Arizona in Yavapai County July 2010 Page 1 of 7 DRP31f American LegalNet, Inc. www.FormsWorkFlow.com [ ] 3. The Respondent is enlisted in the military, and [ ] has deployed for at least one day during the past 6 months. OR [ ] has not been 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 4. 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: 5. 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 Court location Status Superior Court of Arizona in Yavapai County July 2010 Page 2 of 7 DRP31f American LegalNet, Inc. www.FormsWorkFlow.com Nature of the proceeding: 6. 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: 7. [ ] WHY I THINK ______________________________________________ IS NOT THE Name of purported father FATHER OF THE CHILD(REN): (Check which box applies) [ ] AFFIDAVIT: Petitioner and Respondent DID NOT SIGN an Affidavit of Paternity acknowledging that [ ] Petitioner [ ] Respondent is the child(ren)'s natural father. [ ] BIRTH CERTIFICATE: IS NOT NAMED as the natural father on the child(ren)'s birth certificate(s), and/or a father by the name of _______________________________ is named on the child(ren)'s birth certificate(s). [ ] BLOOD TEST: The parties had DNA (Deoxyribonucleic Acid) Testing administered and is shown NOT TO BE the minor child(ren)'s natural father. [ ] 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) and the parties DID NOT LIVE TOGETHER during the period(s) when the child(ren) could have been conceived. [ ] NO SEXUAL INTERCOURSE: Petitioner and Respondent were not living together and DID NOT HAVE sexual intercourse at the probable date of conception of the child(ren). [ ] SEXUAL INTERCOURSE: The mother of the child(ren) HAD sexual intercourse with someone else during the period in which the child(ren)could have been conceived. [ ] OTHER (explain) 8. [ ] I AGREE THAT ___________________________________ IS THE FATHER OF THE ABOVE NAMED CHILD(REN). 9. ABOUT MARRIAGE AND HUSBAND -- check one box. Superior Court of Arizona in Yavapai County July 2010 Page 3 of 7 DRP31f American LegalNet, Inc. www.FormsWorkFlow.com [ ] 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. SUMMARY OF WHAT I SAY ABOUT PATERNITY AND THE CHILD(REN) THAT IS DIFFERENT FROM WHAT THE PETITIONER SAYS IN THE PETITION. ________________________________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ 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.§ 25-320. 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). 15. GENERAL DENIAL: I deny anything stated in the Petition that I have not specifically admitted, qualified or denied. REQUESTS I MAKE TO THE COURT IN THIS CASE: 1. PATERNITY: [ ] Order that ________________________________________ IS NOT THE NATURAL FATHER of the minor child(ren). Superior Court of Arizona in Yavapai County July 2010 Page 4 of 7 DRP31f American LegalNet, Inc. www.FormsWorkFlow.com [ ] 2. Order that ________________________________________ IS THE NATURAL FATHER of the minor child(ren). BIRTH CERTIFICATE: (Mark the box and complete if you want this) [ ] Order that _____________________________ name be added to each child's birth certificate; 3. LAST NAME: (Mark the box and complete if you want this) [ ] Order that each child's last name be changed to last name of __________________________; 4. CUSTODY OF CHILDREN: (Complete A OR B) [ ] 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: Superior Court of Arizona in Yavapai County July 2010 Page 5 of 7 DRP31f American LegalNet, Inc. www.FormsWorkFlow.com 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: 5. CHILD SUPPORT: Support payments will begin on the first day of the first month following the entry of the Dissolution Decree. 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 $ shall be paid by [ ] PETITIONER [ ] RESPONDENT at the rate of $ per month until paid in full. Payments shall be made as stated above. 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. Superior Court of Arizona in Yavapai County July 2010 Page 6 of 7 DRP31f American LegalNet, Inc. www.FormsWorkFlow.com 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 Petitioner must pay all costs and expenses of this lawsuit under Arizona law, if the Court rules in favor of Respondent, including the costs of the blood tests or other genetic testing; filing each child's birth certificate; attorney's fees and court costs. 9. OTHER ORDERS I AM REQUESTING (explain request here): ________________________________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ OATH AND VERIFICATION OF RESPONDENT STATE OF ARIZONA County of __________________ ) ) I, the Respondent, being duly sworn and under oath, state that I have read this Response. All the statements in the Response are true, correct and complete to the best of my knowledge and belief. SIGNED: SUBSCRIBED AND SWORN to before me this Respondent, day of . , 20____ by the NOTARY PUBLIC: My Commission Expires: Copy [ ] mailed [ ] hand-delivered [ ] faxed to: On , 20 By: Superior Court of Arizona in Yavapai County July 2010 Page 7 of 7 DRP31f American LegalNet, Inc. www.FormsWorkFlow.com