(a) Name of Person Filing: _______________________________________ Mailing Address: _______________________________________ City, State, Zip Code: _______________________________________ Daytime Phone Number: _______________________________________ Evening Phone Number: _______________________________________ ATLAS Number (if applicable):_______________________________________ Attorney Bar Number (if applicable):__________________________________ Petitioner Respondent Representing: Self
FOR CLERK'S USE ONLY
SUPERIOR COURT OF ARIZONA MOHAVE COUNTY
Case Number: (Name of Petitioner)
ORDER OF PATERNITY (A.R.S. §25-812F)
AND (Name of Respondent)
(b) For each child, fill in the name, date of birth, and place of birth as listed in the Request for Order of Paternity. Full Name on Birth Certificate ____________________________________ ____________________________________ ____________________________________ Date of Birth ____________ ____________ ____________ Place of Birth (City, County, State) ________________________________ ________________________________ ________________________________
The natural mother of the child(ren) was not married when the child(ren) were born or at any time throughout the ten (10) months immediately preceding such birth. (c) Mother's Full Name:_________________________________________________ Date of Birth ___________ Social Security #: ________________ (* Can be omitted if using the Confidential Sensitive Data Form) Birthplace (City, State, Country:________________________________________________________________ Maiden Name: __________________________________________________
IT IS ORDERED that, based on the Request for Order of Paternity filed pursuant to A.R.S. §25-812, Paternity is established as contained therin. (d) Father's Full Name:__________________________________________________ Date of Birth ___________ Social Security #: ________________ (* Can be omitted if using the Confidential Sensitive Data Form) Birthplace (City, State, Country)_________________________________________ This Order is a Judgment of the Superior Court and imposes a duty of support pursuant to A.R.S. §25-501 et seq. It also provides a basis for determination of issues related to custody and visitation and affords the parents all rights and responsibilities provided by Arizona law. Pursuant to A.R.S. §25-803(D), the parent with whom the child has resided for the greater part of the last six (6) months has legal custody of the child unless otherwise ordered by the Court.
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For children born in Arizona, the Clerk of Superior Court shall send a certified copy of this Order to the Manager, Office of Vital Records, Department of Health Services. For children born outside the state of Arizona, the Clerk shall send a certified copy of the order to Department of Economic Security. Pursuant to A.R.S. §36-326, the Clerk requests that the birth certificate(s) for the above named child(ren) be amended or supplemented to include the name of the above-designated natural father.
VIRLYNN TINNELL, CLERK OF SUPERIOR COURT By: ________________________________________ Deputy Clerk
Copy mailed this date:______________________ to:
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