Name of Person Filing: Mailing Address: City, State, Zip Code: Telephone Number: Attorney Bar Number (if applicable): Representing:
SUPERIOR COURT OF ARIZONA PINAL COUNTY
Name of Petitioner
) ) ) ) ) )
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AFFIDAVIT REGARDING MINOR CHILDREN
Name of Respondent
NOTICE: This "Affidavit Regarding Minor Children" is required for all custody cases. You must fill out this Affidavit completely, and provide accurate information. Use additional paper if necessary. You must give copies of this Affidavit and all other required documents to the other party, and to the judge.
1. CHILDREN OF THE PARTIES WHO ARE UNDER 18 YEARS OLD. The following
child(ren) are under age 18 and were born to, or adopted by, me and the other party: Name: Birthdate: Name: Birthdate: Age: Age: Name: Birthdate: Name: Birthdate: Age: Age:
2.
INFORMATION REGARDING WHERE THE CHILDREN UNDER 18 YEARS OLD HAVE LIVED FOR THE LAST 5 YEARS: (Attach additional pages if necessary)
Child's Name: Address: City, State: Child's Name: Address: City, State: Child's Name: Address: City, State: Child's Name: Address: City, State: Dates: From Lived with: Relationship to Child: Dates: From Lived with: Relationship to Child: Dates: From Lived with: Relationship to Child: Dates: From Lived with: Relationship to Child: To
To
To
To
© Superior Court of Arizona in Pinal County December 16, 2002 ALL RIGHTS RESERVED
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3.
COURT CASES IN WHICH I HAVE BEEN A PARTY/WITNESS THAT INVOLVED THE CUSTODY PARENTING TIME OF THE CHILD(REN): (Check one box)
I have or I have not been a party/witness in court in this state or in any other state that involved the custody parenting time of the child(ren) named above. (If so, explain. If not, go on.) Name of each child: Name of Court: Court Case Number: How the child is involved: Summary of any Court Order: Court Location: Current Status:
4.
INFORMATION REGARDING PENDING COURT CASES RELATED TO THE CUSTODY OF THE CHILD(REN): (Check one box)
I do have or I do not have information about a custody parenting time court case relating to any of the children named above that is pending in this state or in any other state. (If so, explain. If not, go on.) Name of each child: Name of Court: Court Case Number: How the child is involved: Summary of any Court Order: Court Location: Current Status:
5.
CUSTODY OR PARENTING TIME CLAIMS OF ANY PERSON: (Check one box)
I do know or I do not 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 children named in this Affidavit. (If so, explain below. If not, go on.) Name of each child: Name of person with the claim: Address of person with the claim: Nature of the claim:
OATH AND VERIFICATION:
STATE OF ARIZONA PINAL COUNTY ) ) ss.
I have read the "Affidavit Regarding Minor Children" and know of my own knowledge that the information stated in it is true and correct, and that any false information may constitute perjury by me.
SIGNED: Petitioner's Signature SUBSCRIBED AND SWORN TO before me this day of , 20 ,
My Commission Expires:
By Deputy Clerk/Notary Public
© Superior Court of Arizona in Pinal County December 16, 2002 ALL RIGHTS RESERVED
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