For Clerk's Use Only
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): Representing Self Petitioner OR Respondent
SUPERIOR COURT OF ARIZONA MOHAVE COUNTY
Case Number: Name of Petitioner (in original case) AND
PETITION TO MODIFY CHILD CUSTODY, PARENTING TIME ("VISITATION") and SUPPORT
Name of Respondent (in original case) I,
(print your name)
am the Petitioner or Respondent or Other and make the following statements to the court, under oath:
GENERAL INFORMATION: 1. Information about Me
Name: Address: How I am related to child(ren) for whom the CUSTODY/PARENTING TIME order should be changed: Mother or Father or Other: (explain)
Information about the Other Party
Name: Address: How the other party is related to child(ren) for whom the CUSTODY/PARENTING TIME order should be changed: Mother or Father or Other: (explain)
Information about the child(ren) for whom I want the custody/parenting time order changed:
Child's Name Birth date Child's Name Birth date Age: Age: Child's Name Birth date Child's Name Birth date Age: Age:
March 20, 2006
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Affidavit Regarding Minor Children.
of the last Arizona Custody Order or (if not)
The children have resided in Arizona since the entry I have attached an "Affidavit Regarding Minor Children".
Information about the Order I want to change: (Check A or B, then complete the information)
A. The Order is from the Superior Court in Mohave County. (month, day, year). 1. Order/decree is dated: 2. The name of the judge who signed the order is: OR The Order is from the Superior Court in Arizona but from another county or the Order is not from Arizona. The child(ren) have lived in Arizona for at least six (6) months before the date I am filing this Petition. I have filed a certified copy of this Order with the Clerk of the Court, and a copy of the order/decree is attached to this Petition. Order/decree is dated: (month, day, year). Name of state:___________________________________________ Name of county in state:___________________________________
No significant domestic violence has occurred or domestic violence has occurred. Explain ___________________________________________________________________________________
WHAT YOUR ORDER NOW SAYS: Put in WORD FOR WORD the part of the decree/order you
want to change. (Use extra paper if necessary) OR incorporate the Order which is already a part of the court's file, and attach a copy of the Order to the judge's copy of this Petition and all other parties' copies of this Petition. ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________
WHY THE DECREE/ORDER SHOULD BE CHANGED: These are my reasons why I believe
that a change of custody and/or parenting time is in the best interest of the child(ren) (Use extra pages if necessary): __________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________
REQUESTS I MAKE TO THE COURT:
A. CUSTODY AND PARENTING TIME.
Joint Legal Custody. I want the parties to be awarded joint legal custody of the child(ren) subject to a Parenting Plan to be submitted later.
(name(s) of child(ren))
OR Sole custody. Sole custody of should be awarded to Mother Mother or Father or (name(s) of child(ren)) Other and/or Sole custody of (name(s) of child(ren)) should be awarded to Other, subject to parenting time as follows: Father or
March 20, 2006
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Case No. 1. 2. 3. 4. Reasonable parenting time to the parent/party who does not have custody according to the Mohave County Custody and Visitation Guidelines; OR Reasonable parenting time to the parent/party who does not have custody according to the attached Parenting Plan; OR Supervised parenting time but only in the presence of another person; OR No parenting time rights to Mother or Father Supervised parenting time or no parenting time is requested for the following reasons:
Mother or Father should pay child support to the other party in the amount per month on the first day of every month, beginning the first day of month of $ following the filing of this Petition based upon the attached "Child Support Worksheet." All child support payments should be made through the Clerk of the Superior Court/Clearinghouse, and will be subject to an applicable statutory fee through an automatic Order of Assignment.
MEDICAL, DENTAL, VISION CARE
Petitioner should be responsible for providing: medical dental vision care insurance. Respondent should be responsible for providing: medical dental vision care insurance. Medical, dental, and vision care insurance, payments and expenses are based on the information in the Parent's Worksheet for Child Support attached and incorporated by reference. The party ordered to pay must keep the other party informed of the insurance company name, address and telephone number, and must give the other party the documents necessary to submit insurance claims. Non-Covered Expenses. Petitioner is ordered to pay __________ %, AND Respondent is ordered to pay ________ % of all reasonable uncovered and/or uninsured medical, dental, vision care, prescription and other health care charges for the minor child(ren), including co-payments.
INCOME TAX DEDUCTION. Mother should claim the tax deduction for
(name(s) of child(ren)
every year or
every other year.
Father should claim the tax deduction for (name(s) of child(ren) every year or every other year.
OTHER ORDERS. I request further Orders relating to this matter as follows:
OATH OR AFFIRMATION AND VERIFICATION
I swear or affirm that the information on this document is true and correct under penalty of perjury.
Signature Sworn to or Affirmed before me this: (date) My Commission Expires: by
Deputy Clerk or Notary Public
March 20, 2006
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