Free Proposed Paternity Resolution Statement - Arizona


File Size: 23.5 kB
Pages: 3
Date: August 18, 2008
File Format: PDF
State: Arizona
Category: Court Forms - Local
Author: SPickard
Word Count: 667 Words, 4,253 Characters
Page Size: Letter (8 1/2" x 11")
URL

http://pinalcountyaz.gov/Departments/JudicialBranch/ClerkoftheCourt/Documents/Downloads/FamilyLaw/Form5.pdf

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Name: Mailing Address: City, State, Zip Code: Daytime Phone Number: Evening Phone Number: Representing: [ ] Self [ ] Petitioner [ ] Respondent State Bar Number: ARIZONA SUPERIOR COURT, COUNTY OF PINAL

Petitioner/Plaintiff

Case No. DO

Respondent/Defendant

PROPOSED PATERNITY RESOLUTION STATEMENT OF: [ ] FATHER [ ] MOTHER

The undersigned party provides the following specific positions on each of the issues in this case (BE SPECIFIC): 1. IV-D Case: [ ] I receive or have received public assistance that may include AFDC, TANF, or AHCCCS for my children or me. [ ] I have a case with the Division of Child Support Enforcement. Custody: The other parent and I have the following natural or adopted children in common: Child(ren)'s Name(s) Date of Birth Age

2.

I want the child[ren] to live primarily with [ ] Mother [ ] Father and have parenting time with [ ] Mother [ ] Father as follows (check all that apply): [ ] [ ] County Guidelines for reasonable parenting time. In accordance with Every other weekend from: at a.m./p.m. to at a.m./p.m. One-half of the holidays on an alternating basis. For weeks in the summer from to (inclusive). Spring Break from school. Other: Mother [ ] Father [ ] Both parents should make the decisions about the child(ren), such as schools, doctors, etc.

[ [ [ [

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This should be a [ ] sole custody [ ] joint custody arrangement. 3. Child Support: My position on the financial factors necessary to calculate child support under the statewide child support guidelines is as follows (complete in full): Father's Gross Monthly Income: $________________ Mother's Gross Monthly Income: $________________ [ ] Father has other child(ren) not listed above who live(s) in his household. other child(ren) not listed above for whom he pays court-ordered child [ ] Father has support in the amount of $ per month. [ ] Mother has other child(ren) not listed above who live(s) in her household. [ ] Mother has other child(ren) not listed above for whom she pays court-ordered per month. child support in the amount of $ [ ] Medical Insurance should be paid by [ ] Mother [ ] Father. The monthly cost for the child(ren) is $ . [ ] Monthly Child Care Costs for child[ren] is $ . [ ] Extra Education Expenses or Extraordinary Child Adjustments: I believe the court should add the following to the child support calculation (leave blank if none claimed): Description Monthly Amount $ $ $ [ ] Uninsured Medical Expenses should be paid: [ ] Pro rata based upon each party's income as provided in the guidelines; or [ ] Other: % paid by Father and % paid by Mother. [ ] Tax Exemptions for the child[ren] should be divided (check one): [ ] Pro rata based upon each party's income as provided in the guidelines; or [ ] Other: 4. [ ] Past Support should be paid by [ ] Mother [ ] Father for the period of through in the amount of $ . Direct payments for support have been [ ] received by me [ ] paid by me for the period of through in the amount of $ . Past Medical Expenses have been incurred by me (and not reimbursed by insurance) for the period of through in the amount of $ % of those expenses. and the other parent should be ordered to reimburse me for Expenses for pregnancy, childbirth, and genetic testing have been incurred by me (and and the other parent should not reimbursed by insurance) in the amount of $ be ordered to reimburse me for % of those expenses.

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Attorneys' Fees: If the case is settled today, I want the court to order (choose one): [ ] Each party to pay his or her own attorneys' fees and costs. [ ] Mother to pay $ of my attorneys' fees and costs within days. to other party for attorneys' fees and costs within ____days. [ ] Father to pay $ Name Change: I want the child(ren)'s names to be changed as follows:

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10.

Other Issues: Briefly state the other issues that you believe must be resolved to fully settle this case:

11.

Settlement: I verify that the above statements are true upon my best information and belief and I am willing to settle and resolve this case based upon the information provided above. I will be prepared to show documentation to support my position at the time of the conference or hearing.

Date

Signature of [ ] Mother [ ] Father