Free Affidavit Regarding Minor Children - Arizona

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Name of Person Filing: Mailing Address: City, State, and Zip Code: Daytime Phone Number: Evening Phone Number: _________________________________ ATLAS Number (if applicable): State Bar Number (if applicable): Representing: Self Petitioner Respondent

SUPERIOR COURT OF ARIZONA MOHAVE COUNTY
Case Number: ________________________ (Name of Petitioner) AND

AFFIDAVIT REGARDING MINOR CHILDREN

(Name of Respondent)

NOTICE: This "Affidavit Regarding Minor Children" is required for all custody cases. You must fill out this Affidavit completely, and provide accurate information. Use additional paper if necessary. You must give copies of this Affidavit and all other required documents to the other party, and to the judge.
1. CHILDREN OF THE PARTIES WHO ARE UNDER 18 YEARS OLD. The following
child(ren) are under age 18 and were born to, or adopted by, me and the other party. Name Birthdate: Name Birthdate: Name Birthdate: Name Birthdate:

Age: Age:

Age: Age:

2.

INFORMATION REGARDING WHERE THE CHILDREN UNDER 18 YEARS OLD HAVE LIVED FOR THE LAST 5 YEARS.
Child's Name: Address: City, State: Child's Name: Address: City, State: Child's Name: Address: City, State: Dates: From Lived with: Relationship to Child: Dates: From Lived with: Relationship to Child: Dates: From Lived with: Relationship to Child: To

To

To

3.

COURT CASES IN WHICH I HAVE BEEN A PARTY/WITNESS THAT INVOLVED THE CUSTODY/PARENTING TIME OF THE CHILD(REN). (Check one box.)
I have or I have not been a party/witness in court in this state or in any other state that involved the custody/parenting time of the child(ren) named above. (If so, explain on separate paper. If not, go on.)

3/17/2009

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Case No.__________________________ Name of each child: Name of Court: Court Case Number: How the child is involved: Summary of any Court Order:

Court Location: Current Status:

4.

INFORMATION REGARDING PENDING COURT CASES RELATED TO THE CUSTODY OF THE CHILD(REN). (Check one box.)
I do have or I do not have information about a custody/parenting time court case relating to any of the children named above that is pending in this state or in any other state. (If so, explain. If not, go on.) Name of each child: Name of Court: Court Case Number: How the child is involved: Summary of any Court Order: Court Location: Current Status:

5.

CUSTODY OR PARENTING TIME CLAIMS OF ANY PERSON. (Check one box.)
I do know or I do not know a person other than the Petitioner or the Respondent who has physical custody or who claims custody or parenting time rights to any of the children named in this Affidavit. (If so, explain below. If not, go on.) Name of each child: Name of person with the claim: Address of person with the claim: Nature of the claim:

OATH OR AFFIRMATION AND VERIFICATION
State of Arizona Mohave County ) ) ss.

I swear or affirm that the information on this document is true and correct under penalty of perjury. _________________________________________ SIGNATURE ______________________________ DATE

Sworn to or Affirmed before me this ______________ day of ______________________, 20_________ by _________________________________________

My Commission Expires: _______________________

____________________________________ Deputy Clerk or Notary Public

3/17/2009

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