Free Private Juvenile Dependency Cover Sheet - Arizona

Arizona Superior Court, Pinal County
Private Juvenile Dependency Cover Sheet
Pursuant to Rule 4.1 Superior Court Local Rules - Pinal County, please provide the following information. (Type or print)

CASE NUMBER JD 2 PETITIONER'S NAME and ADDRESS
Name: Relationship to Case: Address:

Judge MOTHER'S NAME and ADDRESS
Name: Address: City/State/Zip:

City/State/Zip: Telephone:

Telephone: Attorney's Name and Address:

PETITIONER'S ATTORNEY'S NAME and ADDRESS:
Name/State Bar#: Address:

SPECIAL NEEDS IDENTIFICATION & COMMENTS
________ Interpreter needed________________________(language) Comments: ________________________________________________________ ________________________________________________________ ________________________________________________________

City/State/Zip: Telephone:

________________________________________________________ ________________________________________________________

FEES:

[ ] PAID

[ ] NOT PAID - REASON:

[ ] Political Subdivision/Government Agency [ ] Deferred [ ] Waived

IS THIS AN INDIAN CHILD? ____ YES ______ NO

Tribal Affiliation _____________________________________ Enrollment#:______________________________ Mother DOB:____________ Father DOB:____________ Tribal Affiliation________________________ Tribal Affiliation________________________ Enrollment# _____________ Enrollment# _____________

NAMES OF CHILD(REN) & DOB ______________________________________ ______________________________________

Current Mailing Address _____________________________

Attorney Assigned ________________________

______________________________ ________________________

______________________________________ ______________________________ ________________________ ______________________________________ ______________________________ ________________________

______________________________________ ______________________________ ________________________ ______________________________________ ______________________________ ______________________________________ ________________________

______________________________ ________________________

FATHER'S NAME AND ADDRESS
Name: Address: City/State/Zip: Telephone: Attorney's Name and Address:

Agencies involved (JPO or other, please specify)_____________________________________________

To the best of my knowledge, all information is true and correct.

___________________________________________________ Attorney / Pro Per Signature

NOTICE Effective September 8, 1992 and pursuant to Superior Court (Pinal County), Administrative Order No. 92-15, the Superior Court requires that a "Cover Sheet", which categorizes the cause of action, accompany any new action filed with the Superior Court in Pinal County For this purpose, this form has been developed. The cover sheet will result in increased accuracy of courts records and statistics, and and in reduced processing time for new case filings. Forms will be made available at the Clerk of the Superior Court's Filing Counter. PLEASE DO NOT INCLUDE THIS FORM WITH CASES WHICH HAVE ALREADY BEEN FILED. This form can only be processed at the time of filing New Complaints and Petitions. Thank you for assisting us with our efforts to improve service. Rev 01/26/06

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