Fill and Sign the Case Number Clerk Will Stamp Form

Page 1 of 2 Superior Court of Arizona________________ CountyFamily Court Cover Sheet For Use WITHOUT Minor Children Check only one: Dissolution (Divorce)Legal SeparationAnnulment __________________________Order of Protection Case Number (Clerk will stampOther case # when documents are filed) Instructions: You must provide the following information about yourself and the other party. Type or print neatly in black ink.If more room is needed for Petitioner or Respondent, please attach a separate page.Information About the Petitioner: Information About the Respondent: Name: _________________________________Name: _________________________________Address: _______________________________Address: _______________________________City, State, Zip: __________________________City, State, Zip: __________________________Home phone #: ( )______________________Home phone #: ( )______________________Work phone number: ( )__________________Work phone number: ( )__________________Cell phone/pager: ( ) Cell phone/pager: ( ) Page 2 of 2 ________________________________________Date of Birth: ___________________________Date of Birth: ___________________________Social Security #: ________________________Social Security #: ________________________E-mail address: __________________________E-mail address: __________________________Lawyer’s Name and Bar Number: _____________________________________________________(Provide this information only if YOU have an attorney) Page 3 of 2 Have there been any other cases (EXCLUDING minor traffic offenses) in any court involving members of this family? Yes No. If yes, please describe, and provide case numbers if known: ______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________INTERPRETER: Is an interpreter needed for either of the parties? If so, please check the appropriate boxes below. NOTE: THIS IS NOT A REQUEST FOR AN INTERPRETER, THIS INFORMATION IS TO BE USED FOR INTERNAL PURPOSES ONLY. Petitioner Respondent Language: Spanish Other LOCATION: State the Superior Court location where you are filing these documents): ______________________________________________________________________________ Domestic Violence Section Is anyone mentioned on this cover sheet currently a victim of any family or domestic violence? [ ]Yes[ ]No Has anyone listed on this cover sheet been the plaintiff, defendant, or named in a petition for an Order of Protection?[ ]Yes[ ]No If Yes, please identify: ___________________________________________________________________________ What court was the Order of Protection granted? ___________________________________________________________________________