Free Domestic Relations Cover Sheet - Arizona

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MOHAVE COUNTY SUPERIOR COURT DOMESTIC RELATIONS COVER SHEET

Please provide the following information. You must keep the Court advised of your current mailing address during the pendency of these proceedings. PETITIONER'S NAME and ADDRESS _____________________________________________ Last First Middle _______________________________________________ Mailing Address _______________________________________________ City State Zip Code _______________________________________________ Date of Birth SS# (***SEE NOTE***)
(Date Format: dd/mm/yyyy)

RESPONDENT'S NAME and ADDRESS _______________________________________________ Last First Middle _______________________________________________ Mailing Address _______________________________________________ City State Zip Code _______________________________________________ Date of Birth SS# (***SEE NOTE***)
(Date Format: dd/mm/yyyy)

(Enter number,press tab to format)

_______________________________________________ Daytime Telephone Number (Enter 10 digits, press TAB to format) PETITIONER'S ATTORNEY None

***NOTE*** SOCIAL SECURITY NUMBER MUST BE PROVIDED. IT CAN BE OMITTED FROM THIS DOCUMENT AS LONG AS YOU INCLUDE IT ON THE CONFIDENTIAL SENSITIVE DATA FORM (ATTACHED).

_______________________________________________ Name State Bar No. _______________________________________________ Mailing Address _______________________________________________ City State Zip Code __________________________________________ Telephone Number

IS DOMESTIC VIOLENCE AN ISSUE IN THIS CASE:
TYPE OF ACTION Dissolution With Children Without Children Legal Separation With Children Without Children Annulment With Children Without Children

YES

NO

Paternity/Maternity Custody/Visitation Establish Support Domesticated Decree Foreign Judgment Reciprocal Support

Other:_____________________________________________________________________

NOTICE: In order for proper identification, it is necessary that the above requested information be provided at the time of filing your petition/complaint.

6/5/2008