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SUPERIOR COURT OF ARIZONA (Maricopa County Telecommunications)

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©Superior Court of Arizona in Maricopa County Page 1 of 9
DRCV11f - 010119
ALL RIGHTS RESERVED
Person Filing:
Address (if not protected):
City, State, Zip Code:
Telephone:
Email Address:
ATLAS Number:
Lawyer’s Bar Number:
Representing Self, without a Lawyer or Attorney for Petitioner OR Respondent
SUPERIOR COURT OF ARIZONA
IN MARICOPA COUNTY
Case Number:
Name of Petitioner/Party A
PETITION TO ESTABLISH (Check one box only)
LEGAL DECISION-MAKING (LEGAL CUSTODY),
PARENTING TIME, and CHILD SUPPORT, or
LEGAL DECISION-MAKING (LEGAL CUSTODY)
AND PARENTING TIME (ONLY)
Name of Respondent/Party B
STATEMENTS THE COURT
1. INFORMATION ABOUT ME:
Name:
Address:
Date of Birth:
Occupation:
Relationship to children for whom I want the Primary Residence, Legal Decision-Making and
Parenting Time (or Parenting Time and Child Support) Order:
Mother
Father
Other. My relation to the children is:
2. INFORMATION ABOUTTHE OTHER PARTY:
Name:
Address:
Date of Birth:
Occupation:
Relationship to children for whom I want the Primary Residence, Legal Decision-Making and
Parenting Time (or Parenting Time and Child Support) Order:
Mother
Father
Other. My relation to the children is:
FOR CLERK’S USE ONLY
Case No. _______________
©Superior Court of Arizona in Maricopa County Page 2 of 9 DRCV11f-010119
ALL RIGHTS RESERVED
3. VENUE: This is the proper court to bring this lawsuit under Arizona law because:
It is the county of residence of the Party A, or Party B, or the minor child(ren).
4. JURISDICTION: WHY I AM FILING THIS COURT CASE AGAINST THE OTHER PERSON IN
ARIZONA: (check all that apply)
The other Party is a resident of Arizona.
I believe that I will personally serve the other party in Arizona (see “Service” packet).
The other Party agrees to have the case heard here and will file written papers in the court case.
The other Party lived with the minor child(ren) in this state at some time.
The other Party lived in this state and provided pre-birth expenses or support for the minor child(ren).
The minor child(ren) lives in this state as a result of the acts or directions of the other Party.
The other Party had sexual intercourse in this state as a result of which the minor child may have
been conceived in Arizona.
The other party signed an acknowledgment of paternity that is filed in this state.
The other Party did any other acts that substantially connect the other Party with this state (see a
lawyer to help you determine this).
This Court has jurisdiction to decide legal decision-making matters under Arizona law, A.R.S. §§ 25-
402 and 25-802.
5. STATEMENTS ABOUT PATERNITY AND CHILD SUPPORT:
A. PATERNITY WAS ESTABLISHED BY: (check one box).
(A copy of any Order or document referenced here should already be in the Court file or attached.)
A Court Order for Paternity from this county or previously transferred to this county stating
that
is the natural father of the minor child(ren) included in this Petition. (A.R.S. § 25-502(c))
Both parents signing an Acknowledgment of Paternity through the Hospital Paternity
Program or other means provided by law after July 18, 1996, and a birth certificate listing the name
of the father was issued as a result.
We do not have an order of paternity, but we do have a child support order.
*NOTE: If married when minor child(ren) born, conceived or adopted, and no decree of Divorce or Separation has been
issued, STOP! Do not use these forms unless advised to do so by an attorney. Requests for legal decision-making
authority (custody) and parenting time must generally be filed as part of a case for Legal Separation or Divorce.
4. INFORMATION ABOUT MINOR CHILD(REN) FOR WHOM I WANT THE COURT ORDER(S):
B. INFORMATION ABOUT CHILD SUPPORT FOR MINOR CHILDREN:
There is an order for Child Support, dated ______________________________________ from
(name of court)_______________________________________________________________.
This order needs does not need to be changed.
There is a pending child support petition or modification currently filed in this court or another.
Case No. _______________
©Superior Court of Arizona in Maricopa County Page 3 of 9 DRCV11f-010119
ALL RIGHTS RESERVED
To my knowledge there is no child support order for the minor child(ren) and the court should
order child support in this case along with legal decision-making (custody), and parenting time.
Party A Party B made voluntary/direct support payments that need to be taken into
account, if past support is requested.
Party A Party B owes past support for the period between:
the date this petition was filed and the date current child support is ordered.
OR
the date the parties started living apart, but not more than three years before the date of
this petition was filed, and the date current child support is ordered.
6. INFORMATION ABOUT MINOR CHILDREN, including past 5 years residence:
A. Child’s Name:
Gender:
Female Male
Place of Birth:
Date of Birth:
Current Address:
(include city, state)
How long at this address:
County:
Lived with Party A Party B Other (Name & Relation to Child):
(If less than 5 years, provide 5 years previous address information for each child.)
Previous Address:
How long at this address:
Lived with Party A Party B Other:
Previous Address:
How long at this address:
Lived with Party A Party B Other:
B. Child’s Name:
Gender:
Female Male
Place of Birth:
Date of Birth:
Current Address:
(include city, state)
How long at this address:
County:
Lived with Party A Party B Other (Name & Relation to Child):
(If less than 5 years, provide 5 years previous address information for each child.)
Previous Address:
How long at this address:
Lived with Party A Party B Other:
Previous Address:
How long at this address:
Lived with Party A Party B Other:
Case No. _______________
©Superior Court of Arizona in Maricopa County Page 4 of 9 DRCV11f-010119
ALL RIGHTS RESERVED
C. Child’s Name:
Gender:
Female Male
Place of Birth:
Date of Birth:
Current Address:
(include city, state)
How long at this address:
County:
Lived with Party A Party B Other (Name & Relation to Child):
(If less than 5 years, provide 5 years previous address information for each child.)
Previous Address:
How long at this address:
Lived with Party A Party B Other:
Previous Address:
How long at this address:
Lived with Party A Party B Other:
D. Child’s Name:
Gender:
Female Male
Place of Birth:
Date of Birth:
Current Address:
(include city, state)
How long at this address:
County:
Lived with Party A Party B Other (Name & Relation to Child):
(If less than 5 years, provide 5 years previous address information for each child.)
Previous Address:
How long at this address:
Lived with Party A Party B Other:
Previous Address:
How long at this address:
Lived with Party A Party B Other:
Continues on attached page(s) made part of this document by reference.
7. COURT CASES NOT INVOLVING PHYSICAL CUSTODY, LEGAL DECISION-MAKING
(LEGAL CUSTODY) OR PARENTING TIME RELATED TO THE CHILDREN UNDER 18
YEARS OLD: (check one box) I HAVE I HAVE NOT been a party or a witness in court in
this state or any other state NOT involving the legal decision-making (custody) or parenting time of any of
the minor children named above (If so, explain below, using extra pages if necessary. IF NOT, GO ON.)
Name of each child:
Court State:
Court location (county/city):
Court case number:
Current case status:
How the minor children are involved:
Summary of any Court Order:
Case No. _______________
©Superior Court of Arizona in Maricopa County Page 5 of 9 DRCV11f-010119
ALL RIGHTS RESERVED
8. PHYSICAL CUSTODY, LEGAL DECISION-MAKING (LEGAL CUSTODY) OR
PARENTING TIME CASES RELATED TO CHILDREN UNDER 18 YEARS OLD: (Check one box)
I DO NOT HAVE I DO HAVE information about a legal decision-making (custody) or parenting
time court case relating to any of the minor children named above that is pending in this state or in any other
state (If so, explain below, using extra pages if necessary. IF NOT, GO ON).
Name of each child:
Court State:
Court location (county/city):
Court case number:
Current case status:
Nature (type) of court proceeding:
Summary of any Court Order:
9. PHYSICAL CUSTODY, LEGAL DECISION-MAKING (LEGAL CUSTODY) OR
PARENTING TIME CLAIMS OF ANY PERSON:
(Check one box)
I DO NOT KNOW I DO KNOW a person other than the Petitioner or the Respondent who has
physical custody or who claims legal decision-making authority (custody) or parenting time rights to any of
the minor children named above. (If so, explain below, using extra pages if necessary. IF NOT, GO ON).
Name of each child:
Name of Person with the claim:
Address of Person with the claim:
Nature of the Claim:
OTHER STATEMENTS TO THE COURT:
10. OTHER EXPENSES: The parties should be ordered to divide between them any uninsured medical,
dental, or health expenses, reasonably incurred for the minor child(ren), in proportion to their respective
incomes.
Case No. _______________
©Superior Court of Arizona in Maricopa County Page 6 of 9 DRCV11f-010119
ALL RIGHTS RESERVED
11. DOMESTIC VIOLENCE: (If you are asking for joint legal decision-making (joint legal custody); this
statement must be true (ARS § 25-403).
Domestic Violence has not occurred in this relationship.
There has been domestic violence in this relationship and no legal decision-making (custody) should
be awarded to the party who committed the violence.
Domestic Violence has occurred but it was committed by both parties or it is otherwise still in
the best interests of the minor child(ren) to grant joint or sole legal decision-making (joint or sole
custody) to a parent who has committed domestic violence because: (Explain.)
12. The Parent Information Program (PIP) is required for persons seeking legal decision-making
authority (custody) or parenting time. (Check one box)
I have I have not already completed the Parenting Information Program.
13. DRUG / ALCOHOL CONVICTION WITHIN LAST TWELVE MONTHS:
(If you intend to ask for joint legal decision-making (joint custody), check one box.)
Neither parent has been convicted for a drug offense or driving under the influence of drugs or
alcohol in the last twelve (12) months, OR
One or both parents have been convicted for a drug offense or driving under the influence of
drugs or alcohol in the last twelve (12) months.
Party A and/or Party B was convicted, however, the legal decision-making (legal
custody) and parenting time arrangement I am requesting appropriately protects the minor
child(ren).
Explain how this arrangement appropriately protects the children.
Case No. _______________
©Superior Court of Arizona in Maricopa County Page 7 of 9 DRCV11f-010119
ALL RIGHTS RESERVED
REQUESTS TO THE COURT:
PRIMARY RESIDENCE, PARENTING TIME, AND AUTHORITY FOR LEGAL DECISION-
MAKING (LEGAL CUSTODY):
1. Declare the “Primary Residence” for each minor child as follows:
NEITHER parent’s home is designated as the primary residence, OR
Declare Party A’s home as the primary residence for the following named children:
Declare Party B’s home as the primary residence for the following named children:
2. PARENTING TIME: Award parenting time as follows:
Reasonable parenting time rights as described in the Parenting Plan, OR
Supervised parenting time between the children and Party A OR Party B, OR
No parenting time rights to the Party A OR Party B.
Supervised or no parenting time is in the best interests of the child(ren) because: *
Explanation continues on attached pages made part of this document by reference.
a. Name this person to supervise:
b. Restrict parenting time as follows:
c. Order cost of supervised parenting time (if applicable) to be paid by:
Party A
Party B, OR
Shared equally by the parties.
Case No. _______________
©Superior Court of Arizona in Maricopa County Page 8 of 9 DRCV11f-010119
ALL RIGHTS RESERVED
3. AUTHORITY FOR LEGAL DECISION-MAKING (LEGAL CUSTODY):
Award legal authority to make decisions concerning the child(ren) as follows:
Award sole authority for legal decision-making to: Party A Party B
OR
Award joint legal decision-making authority to both parties. Party A and Party B will agree to act as joint
legal decision-makers concerning the minor child(ren) and will submit a Parenting Plan and Joint Legal
Decision-Making Agreement signed by both parties.
(For the court to order “joint” legal decision-making, there must have been no “significant” domestic
violence according to Arizona law, A.R.S. § 25-403.03)
4. CHILD SUPPORT:
(Check below if you are asking for a child support order or a change of child support in this case.)
Order that child support shall be paid by: (check one box)
Party A OR Party B
in a reasonable amount as determined by the court under the Arizona Child Support Guidelines.
OR
in the amount of $_________________, which is a deviation from the amount set forth under
the Arizona Child Support Guidelines. I am requesting a deviation because: (EXPLAIN)
Support payments shall begin on the first day of the first month following the entry of support order. These
payments, and a fee for handling, shall be paid through the Support Payment Clearinghouse, PO Box 52107,
Phoenix, Arizona 85072-7107 and collected by automatic Income Withholding Order.
Order that
past child support
be paid by
Party A
Party B
in an amount determined by
using a retroactive application of the Arizona Child Support Guidelines taking into account any
amount of temporary or voluntary / direct support that has been paid. Support to be paid as defined
above.
5. MEDICAL, DENTAL, VISION CARE
Party A should be responsible for providing: medical dental vision care insurance.
Party B should be responsible for providing: medical dental vision care insurance.
Party A and Party B will share all reasonable unreimbursed medical, dental, vision care, and health
related expenses incurred for the minor child(ren) in proportion to their respective incomes.
Case No.
©Superior Court of Arizona in Maricopa County Page 9 of 9 DRCV11f-010119
ALL RIGHTS RESERVED
6. TAX EXEMPTION. Allocate tax exemptions for the minor child(ren) as determined by the court under
the Arizona Child Support Guidelines and in a manner that allows each party to claim allowable federal
dependency exemptions proportionate to adjusted gross income in a reasonable pattern that can be
repeated.
Under the Affordable Care Act, the party who claims the child as a dependent on a federal tax return has
the obligation to ensure that the child is covered by medical insurance and may be penalized by the IRS
for failing to do so.
The parties will claim the children as income tax dependency exemptions on federal and state income tax
returns as follows:
Parent entitled to claim Name of minor child in Tax Year
Party A
Party B
Party A
Party B
Party A
Party B
Party A
Party B
Party A
Party B
Pattern shall repeat for subsequent years.
7. OTHER ORDERS I AM REQUESTING (explain request here):
DECLARATION UNDER PENALTY OF PERJURY
I declare that the contents of this document are true and correct under penalty of perjury.
Date
Party Filing Petition’s Signature
Party Filing Petition’s Printed Name
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SUPERIOR COURT OF ARIZONA (Maricopa County Telecommunications)

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Completed 15 June 2021

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