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 Respondent
SUPERIOR COURT OF ARIZONA MOHAVE COUNTY
Case Number: (Name of Petitioner) AND
PETITION FOR DISSOLUTION OF A NON-COVENANT MARRIAGE (DIVORCE) WITH CHILDREN
(Name of Respondent)
STATEMENTS MADE TO THE COURT, UNDER OATH:
NOTE: *Social Security Number can be omitted if using Confidential Sensitive Data Form 1. INFORMATION ABOUT ME, THE PETITIONER:
Name: Address: Date of Birth_______________________ Social Security #_____________________(*Can be omitted if using the Confidential Sensitive Data Form) Job Title: Starting with today number of months/years in a row, you, the Petitioner, have lived in Arizona:
INFORMATION ABOUT MY SPOUSE, THE RESPONDENT:
Name: Date of Birth_______________________ Address: Social Security #_____________________(*Can be omitted if using the Confidential Sensitive Data Form) Job Title: Starting with today number of months/years in a row, the Respondent has lived in Arizona:
INFORMATION ABOUT MY MARRIAGE:
Date of Marriage: City and state or country where we were married: We do not have a covenant marriage. We do have a covenant marriage. (Warning: If you have a covenant marriage, you cannot use this form. If you have questions about whether you have a covenant marriage, review your marriage license, review the checklist in this packet, and see a lawyer for help.)
90 DAY REQUIREMENT:
I OR my spouse have lived, or have been stationed while a member of the Armed Forces, in Arizona for at least 90 days before I filed this action. (WARNING: If this statement is not true, you cannot file your case in Arizona.)
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DOMESTIC VIOLENCE: (Check the box that is true if you intend to ask for joint custody): Domestic violence has not occurred during this marriage or Domestic violence has occurred, but the domestic violence has not been significant. CHILDREN OF THE PARTIES WHO ARE LESS THAN 18 YEARS OLD (check one box):
There are no children under the age of 18 either born to, or adopted by, the parties. NOTE: IF YOU CHECKED THIS BOX, STOP. YOU SHOULD BE USING THE PETITION PACKET TO GET A DIVORCE WITHOUT CHILDREN. The following child(ren) are under age 18 and were born to or adopted by my spouse and me: (Attach extra pages if necessary). Child's Name: Address: Social Security #_____________________(*Can be omitted if using the Confidential Sensitive Data Form) Length of Time at Address: Child's Name: Address: Social Security #:_____________________(*Can be omitted if using the Confidential Sensitive Data Form) Length of Time at Address: Child's Name: Address: Social Security #:_____________________(*Can be omitted if using the Confidential Sensitive Data Form) Length of Time at Address: Child's Name: Address: Social Security #:_____________________(*Can be omitted if using the Confidential Sensitive Data Form) Length of Time at Address:
PREGNANCY and PATERNITY: (check one box)
Wife is not pregnant, OR Wife is pregnant The baby is due on (date), (and, check one box below): The Petitioner and Respondent are the parents of the child, OR Petitioner is not the parent of the child, OR Respondent is not the parent of the child A child or children was/were born before the marriage. The husband is the father of that child/ those children named below:
COMMUNITY PROPERTY: (check one box)
My spouse and I did not acquire any community property during the marriage, OR My spouse and I acquired community property during our marriage, and we should divide it as follows:
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Case No.____________________ Petitioner Respondent Real estate located at: $ Legal Description: Value
Petitioner Respondent Real estate located at: Legal Description:
Household furniture and appliances:
Value $ $ $ $ $ $
Value $ $ $ $ $ $
Value $ $ $ $
Pension/retirement fund/profit sharing/stock plan/401K: Petitioner Respondent
Value $ $ $ $ Value $
Motor vehicles: Make Model VIN Lien Holder 4/7/2006 Page 3 of 8
Case No.___________________ Petitioner Respondent Make Model VIN Lien Holder Value $
SEPARATE PROPERTY: (Check all boxes that apply.)
I do not have any property that I brought into the marriage or separate property. My spouse, the Respondent does not have any property that he or she brought into the marriage or separate property. I have property that I brought into the marriage or I have separate property. I want this property awarded to me as described below. My spouse, the Respondent, has property that he or she brought into the marriage or has separate property. I want this property awarded to my spouse as described below. Separate Property: (List the property and the value of the property, and check the box to tell the Court who should get the property.) Description of Separate Property Petitioner Respondent Value $ $ $ $
COMMUNITY DEBTS: (check one box)
My spouse and I did not incur any community debts during the marriage, OR We should divide the responsibility for the debts incurred during the marriage as follows: DESCRIPTION OF DEBT Petitioner Respondent Amount Owed $ $ $ $ $ $
SEPARATE DEBTS: (Check all boxes that apply.)
My spouse and I do not have any debts that were incurred prior to the marriage or separate debt; I have separate debt or debt that I incurred prior to the marriage that should be paid by me as described below; My spouse has separate debt or debt that he or she incurred prior to the marriage that should be paid by my spouse as described below.
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Case No.___________________ DESCRIPTION OF DEBT Petitioner Respondent Amount Owed $ $ $ $
TAX RETURNS: (Check this box if this is what you want).
After the judge or commissioner signs the Decree of Dissolution of Marriage (Divorce), we will, subject to IRS Rules and Regulations, pay federal and state taxes as follows: For previous years (the years we were married, not including the year the Decree was signed), the parties will file joint federal and state income tax returns. In addition, for previous calendar years, both parties will pay, and hold the other harmless from,1/2 of all additional income taxes if any and other costs, and each will share equally in any refunds. For the calendar year (the year that the Decree is signed) and all future calendar years, each party will, subject to IRS Rules and Regulations, file separate federal and state income tax returns. Each party will give the other party all necessary documentation to do so.
SPOUSAL MAINTENANCE/SUPPORT (ALIMONY) (check the box that applies to you):
Neither party is entitled to spousal maintenance/support (alimony), OR Petitioner OR Respondent is entitled to spousal maintenance/support because: (Check one or more of the box(es) on the next page that apply. At least one reason must apply to get spousal maintenance/support.) Person lacks sufficient property to provide for his/her reasonable needs; Person is unable to support himself/herself through appropriate employment; Person is the custodian of a child(ren) whose age or condition is such that the person should not be required to seek employment outside the home; Person lacks earning ability in the labor market adequate to support himself/herself; and Person contributed to the educational opportunities of the other spouse or had a marriage of long duration and is now of an age that precludes the possibility of gaining employment adequate to support himself/herself.
OTHER STATEMENTS TO THE COURT UNDER OATH: To file for divorce of non-covenant
marriage, you must be able to tell the court that the following statements are true. If the statements are not true, you cannot file for divorce until the statements are true. Check the box in front of each statement if the statement is true. TRUE My marriage is irretrievably broken and there is no reasonable prospect of reconciliation. (My marriage is over.) TRUE My spouse and I have attempted to resolve our problems by using Conciliation Services, or going to Conciliation Services to try to resolve our problems would not work. TRUE This court has jurisdiction to decide child custody matters under Arizona law.
WRITTEN CUSTODY AGREEMENT: (Check the boxes that apply, if they apply)
My spouse and I have a written agreement signed by both of us about the custody, visitation, and child support for our child(ren). I have attached a copy of the written agreement.
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REQUESTS TO THE COURT:
A. DISSOLUTION (DIVORCE):
Dissolve our marriage and return each party to the status of a single person;
wife husband to her or his former name of WARNING: If you are not the person who is requesting to have your former name restored, the court must have a written request from the party who wants his or her name restored to change the name.
PATERNITY and CHILDREN'S NAMES: Declare the husband to be the father of the
following named child(ren) born before the marriage and (optional) change the legal name of those children to the name listed on the right, below : Current Legal Name (OPTIONAL) Change the name of the child to: New Name
CHILD CUSTODY AND VISITATION: Award custody and visitation of the children under the age of 18 years and common to the parties, whether by birth or adoption, as follows: (Check either the sole custody box or the joint custody box. If you check the sole custody box, check only one box related to visitation.)
C.1. SOLE CUSTODY of the minor child(ren) awarded to subject to visitation as follows: Petitioner OR Respondent,
Reasonable Visitation rights to the parent not having custody, as will be described in the Parenting Plan attached to the Divorce Decree. Supervised Visitation between the children and the Petitioner OR Respondent is in the best interest of the children because: (Explain the reasons or need for supervised visitation. Use extra paper if necessary.) Name of the person who will supervise: Requested restrictions on visitation: (explain here) The cost of supervised parent/child access will be paid by the parent being supervised; the parent having custody; shared equally by the parties. No Visitation rights to the parent not having custody is in the best interests of the child(ren) because: (Explain the reasons for no visitation. Use extra paper if necessary): OR
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Case No.____________________ C.2. JOINT CUSTODY: Petitioner and Respondent agree to act as joint custodians of the minor child(ren) as set forth in the Joint Custody Agreement signed by the parties, if the court agrees with the Joint Custody Agreement. (Remember, there can be no domestic violence in your marriage.)
CHILD SUPPORT: Order that child support will be paid by: Petitioner, OR Respondent in a reasonable amount as determined by the court under the Arizona Child Support Guidelines. Support payments will begin on the first day of the first month following the entry of the divorce decree. These payments, and a fee for handling, will be paid through the Clerk of the Court/Clearinghouse and collected by automatic wage assignment. INSURANCE AND HEALTH CARE EXPENSES FOR CHILDREN: Order that
Petitioner OR Respondent will pay for the health, medical, and dental insurance coverage for the child(ren) common to the parties and under the age of 18 years. Petitioner and Respondent will pay for all reasonable unreimbursed medical, dental, and health-related expenses incurred for the child(ren) in proportion to their respective incomes.
TAX EXEMPTION: The parties will claim the children as income tax dependency exemptions on
federal and state income tax returns as follows: Parent entitled to claim Petitioner Respondent Petitioner Respondent Parent entitled to claim Petitioner Respondent Petitioner Respondent Name of child Current tax year Later tax years ________________________________________________________ ________________________________________________________ Name of child Current tax year Later tax years ________________________________________________________ ________________________________________________________
SPOUSAL MAINTENANCE/SUPPORT (ALIMONY):
Order spousal support to be paid by Petitioner OR Respondent in the amount of per month beginning with the first day of the month after the Judicial Officer signs the Decree and continuing until the person receiving spousal maintenance/support is remarried or deceased, or for a period of months.
COMMUNITY PROPERTY: Make a fair division of all community property. COMMUNITY DEBTS: Order each party to pay community debts as requested in the Petition,
and to pay any other community debts unknown to the other party. Order each party to pay and hold the other party harmless from debts incurred by him/her since the parties separation on ____________ or the date the Respondent was served with the Petition for Dissolution.
SEPARATE PROPERTY and DEBT: Award each party his/her separate property and make
each party pay his/her own separate debt.
OTHER ORDERS I AM REQUESTING (Explain request here): __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ __________________________________________________________________
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AFFIRMATION OF PETITIONER:
I declare under penalty of perjury that the contents of this document are true and correct to the best of my knowledge and belief.
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