Fill and Sign the Affidavit Regarding Minor Children Form

Person Filing: Address (if not protected): City, State, Zip Code: Telephone Numbers: Email Address: ATLAS Number (if applicable): Representing [ ] Self or [ ] Lawyer for Lawyer Bar Number: SUPERIOR COURT OF ARIZONA IN COUNTY Case Number: Petitioner AFFIDAVIT REGARDING MINOR CHILDREN Respondent NOTICE: This Affidavit Regarding Minor Children is required for all legal decision-making (custody) cases. If you are asking to modify an existing Arizona legal decision-making order, it is only required if the children have lived outside the state at some time in the last 5 years. 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 parent, and to the judge. 1. CHILDREN OF THE PARTIES WHO ARE UNDER 18 YEARS OLD. The following children are under age 18 and were born to, or adopted by, me and the other party. Name: Name: Birthdate: Age: Birthdate: Age: Arizona Supreme Court Page 1 of 6 DRCVG13F-030217For Clerk’s Use Only Case Number: Name: Name: Birthdate: Age: Birthdate: Age: [ ] Same information about additional children continues on attachment. Arizona Supreme Court Page 2 of 6 DRCVG13F-030217 Case Number: 2. INFORMATION REGARDING WHERE THE CHILDREN UNDER 18 YEARS OLD HAVE LIVED FOR THE LAST 5 YEARS (or since birth, if younger than 5). Child’s Name: Dates: From To Address: City, State: Lived with: Relationship to Child: Child’s Name: Dates: From To Address: City, State: Lived with: Relationship to Child: Child’s Name: Dates: From To Address: City, State: Lived with: Relationship to Child: Child’s Name: Dates: From To Address: City, State: Arizona Supreme Court Page 3 of 6 DRCVG13F-030217 Case Number: Lived with: Relationship to Child: [ ] Same information about additional children or locations continues on attachment. 3. COURT CASES IN WHICH I HAVE BEEN A PARTY/WITNESS THAT INVOLVED THE LEGAL DECISION-MAKING (CUSTODY) AND/OR PARENTING TIME OF THE MINOR CHILDREN. (Check one box.) [ ] I have [ ] I have not been a party/witness in court in this state or in any other state that involved the legal decision-making (custody) and/or parenting time of the children named above. (If so, complete the following. If not, go on.) Name of each child: Name of Court: Court Location: Court Case Number: Current Status: How the child is involved: Summary of any Court Order: 4. INFORMATION REGARDING PENDING COURT CASES RELATED TO THE LEGAL DECISION-MAKING AUTHORITY (CUSTODY) OF THE MINOR CHILDREN. (Check one box.) [ ] I do have [ ] I do not have information about a legal decision-making (custody) court case relating to any of the children named above that is pending in this state or in any other state. (If so, complete the following. If not, go on.) Name of each child: Name of Court: Court Location: Court Case Number: Current Status: How the child is involved: Arizona Supreme Court Page 4 of 6 DRCVG13F-030217 Case Number: Summary of any Court Order: 5. LEGAL DECISION-MAKING (CUSTODY) OR PARENTING TIME CLAIMS OF ANY PERSON . (Check one box.) [ ] I do [ ] I do not know a person other than me or the other party who has physical custody or who claims legal decision-making (custody) or parenting time rights to any of the children named in this Affidavit. (If so, complete the following. If not, go on.) Name of each child: Name of person with the claim: Address of person with the claim: Nature of the claim: Arizona Supreme Court Page 5 of 6 DRCVG13F-030217 Case Number: OATH OR AFFIRMATION AND VERIFICATION I swear or affirm that the information on this document is true and correct under penalty of perjury. Date Signature STATE OF COUNTY OF Subscribed and sworn to or affirmed before me this: by (date) . (notary seal) Deputy Clerk or Notary Public Arizona Supreme Court Page 6 of 6 DRCVG13F-030217