Fill and Sign the Ii I Ii National Center for State Courts Form

Name:_________________________________________________ Address:_______________________________________________ City, State. Zip:_________________________________________ Telephone:_____________________________________________ State Bar Code:_________________________________________ Client:_________________________________________________ Atlas # ________________________________________________ IN THE SUPERIOR COURT OF THE STATE OF ARIZONA In and for the County of _____________ ______ __________________________________________ IN RE THE MATTER OF: CASE NO. ___________________________________, Petitioner PETITION FOR MODIFICATION OF: vs. [ ] CHILD CUSTODY, [ ] VISITATION AND [ ] SUPPORT ___________________________________, Respondent ____________________________________________________________________________ STATEMENTS MADE TO THE COURT, UNDER OATH GENERAL INFORMATION: 1. Information about the Petitioner: Name: __________________________________________________________________ Address: ________________________________________________________________ Date of Birth: ____________________________________________________________ Social Security No.: _______________________________________________________ Occupation: ______________________________________________________________ Relationship to Children: ___________________________________________________ 2. Information about the Respondent: Name: __________________________________________________________________ Address: ________________________________________________________________ Date of Birth: ____________________________________________________________ Social Security No.: _______________________________________________________ Occupation: ______________________________________________________________ Relationship to Children: _____________ ______________________________________ 3. Information about the children for whom the Modification id being requested: Name: 1. _________________________ 2. _________________________ 3. _____________________________ Soc. Sec. No.: 1. ________________ _______ 2. __________________________ 3. ______________________ Date of Birth: 1. _______________________ 2. _______________________ 3. ____________________________ County of Residence: 1. _____________________ 2. _____________________ 3. ______________ ____________ Current Address: 1. ______________________ 2. ______________________ 3. ___________________________ Father: 1. _______________________ 2. _________________________ 3. _____________________________ Mother: 1. _________________________ 2. ____ _____________________ 3. ____________________________ 4. About the Order I am requesting a Modification of: A. [ ] The Custody / Visitation Order is by the Superior Court in Maricopa County. ( Answer 1 or 2 below: ) 1. [ ] If the current Order is for Sole Custody: Order / Decree dated ______________________________ giving sole custody of the minor child(ren) to [ ] Petitioner [ ] Respondent. 2. [ ] If the current Order is for Joint Custody: Order / Decree dated ______________________ _______ giving joint custody of the minor child(ren) to both the Petitioner and Respondent, but [ ] Petitioner OR [ ] Respondent was given primary care of the child(ren). B. [ ] The current Custody / Visitation Order regarding the child(ren) is from t he Superior Court in Arizona but from the County of _________________________________ and is dated ________________________________. [ ] The Custody / Visitation Order is not from the State of Arizona but is from the State of _________________, County of _____________________________, and is dated __________________________ ( The child(ren) have lived in the State of Arizona for at least 6 ( six ) months before the filing of this Petition. I have filed a Certified Copy of the Order / Decree with the Clerk of this Court, and a copy of the Order / Decree is attached to this Petition. ( NOTE: If the child(ren) have not lived in the State of Arizona for at least 6 ( six ) months, you may wish to seek legal advice before proceeding further. ) 5. How lon g has the Custody / Visitation Order that I want changed been active: ( check only ONE box under A or B. But, if you check B -3, be sure to complete all the information.) A. For a Sole Custody Order / Decree: ( One box only ) 1. [ ] The Order / Decr ee is at least one year old. 2. [ ] Less than one year has passed since the Order / Decree was signed, but, I want to change the existing Order because I have reason to believe the child(ren)'s present surroundings may endanger the child(ren)'s physi cal, mental, moral or emotional health. ( NOTE: If you check this box, be sure you explain the situation in detail in your Affidavit. ) B. For a Joint Custody Order / Decree: ( One box only ) 1. [ ] There is now a Order / Decree for joint custody an d I make this request at least one year after the Judicial Officer signed the Order / Decree. 2. [ ] There is currently a Order / Decree for joint custody and I am making this request at least 6 ( six ) months after the Judicial Officer signed the Order / Decree because the other parent has failed to follow the Order / Decree. 3. [ ] This request is being made less than 6 ( six ) months after the Judicial Officer signed the Order / Decree, but since the Order / Decree was signed there has been [ ] D omestic Violence between the parties [ ] Spousal Abuse or [ ] Child Abuse has occurred. ( check one or more above and fill in the information below ) Date action was reported to Law Enforcement or other Governmental Agency: ___________________________ Name and location of agency: ____________________________________________________________________ Court or Agency Case Number: __________________________________________________________________ Name of Court, if Court case was filed: ______________________ ______________________________________ Location and address of Court: ___________________________________________________________________ 6. The existing Order currently states: State WORD FOR WORD what your current Order / Decree says where it applies to custody and/or visitation with child support. __________________________________________________________________________________________ ___ __________________________________________________________________________________________ ___ ___________ _______________________________________________________________________________ ___ __________________________________________________________________________________________ ___ _______________________________________________________________________________ ___________ ___ __________________________________________________________________________________________ ___ __________________________________________________________________________________________ ___ 7. State reasons for request for Modification of cu rrent Order / Decree: __________________________________________________________________________________________ ___ __________________________________________________________________________________________ ___ ______________________________________________ ____________________________________________ ___ __________________________________________________________________________________________ ___ __________________________________________________________________________________________ ___ ____________________ ______________________________________________________________________ ___ __________________________________________________________________________________________ ___ 8. What you would like the changed Order / Decree to state: _________________________ _________________________________________________________________ ___ __________________________________________________________________________________________ ___ __________________________________________________________________________________________ ___ __________________________________________________________________________________________ ___ __________________________________________________________________________________________ ___ ___________________________________________________________________ _______________________ ___ __________________________________________________________________________________________ ___ Other Information About the Children: 9. Where the children have lived for the last 5 ( five ) years: Current Address Name: 1. ____________________________ 2. ___________________________ 3. ________________________ Address ( city and state ): 1. ______________________________________________________________________ 2. ___________________________________________________ _______________________________________ _ 3. __________________________________________________________________________________________ _ Dates From to Present: 1. ________________________ 2. _______________________ 3. ___________________ Living with whom: 1 . ________________________ 2. _______________________ 3. ______________________ Relationship to the child: 1. _______________________ 2. ______________________ 3. ___________________ Name: 1. ____________________________ 2. _______________________ ____ 3. ________________________ Address ( city and state ): 1. ______________________________________________________________________ 2. __________________________________________________________________________________________ _ 3. ______________________ ____________________________________________________________________ _ Dates From --- to --- : 1. _________________________ 2. ________________________ 3. ____________________ Living with whom: 1. ________________________ 2. _______________________ 3. ____ __________________ Relationship to the child: 1. _______________________ 2. ______________________ 3. ___________________ Name: 1. ____________________________ 2. ___________________________ 3. ________________________ Address ( city and state ): 1. ______________________________________________________________________ 2. __________________________________________________________________________________________ _ 3. _______________________________________________________________________________________ ___ _ Dates From --- to --- : 1. _________________________ 2. ________________________ 3. ____________________ Living with whom: 1. ________________________ 2. _______________________ 3. ______________________ Relationship to the child: 1. _______________ ________ 2. ______________________ 3. ___________________ 10. Court cases NOT involving custody and/or visitation related to the child(ren) in a case under 18 years old: (Check one Box ) I [ ] have [ ] have not been a party or a witness in a Court i n this state or any other state not involving the custody and/or visitation of any of the children named above. If so, explain: Name of child(ren) involved: _____________________________________________________________________ Court: __________________________________ Court Location: _______________________________________ Case Number: ___________________________ Status: _______________________________________________ How is the child(ren) involved: ____________________________ _______________________________________ __________________________________________________________________________________________ ___ Summarize any Court Order: ____________________________________________________________________ __________________________ ________________________________________________________________ ___ 11. Custody and/or visitation cases related to child(ren) under 18 years old: ( Check one Box ) I [ ] do [ ] do not have information about a custody or visitation Court case relating to any of the children named above that is pending in this state or any other. If so, explain: Name of child(ren) involved: _____________________________________________________________________ Court: __________________________________ Court Location: __ _____________________________________ Case Number: ___________________________ Status: _______________________________________________ Nature of the Proceedings: _______________________________________________________________________ _____________________ _____________________________________________________________________ ___ Summarize any Court Order: ____________________________________________________________________ _______________________________________________________________________________________ ___ ___ 12. Custody or visitation claims of ANY person: ( Check one Box ) I [ ] do [ ] do not know a person other than the Petitioner or the Respondent who has physical custody or who claims custody or visitation rights to any of the children named abo ve. If so, explain: Name of child(ren) involved: _____________________________________________________________________ Name of claiming person: _______________________________________________________________________ Address of claiming person: ______________________________________________________________________ Nature of claim: _______________________________________________________________________________ ____________________________________________________________ ______________________________ ___ Requests I make to the Court for Modification of Custody and Visitation with Child Support and Related Matters: 1. Custody and Visitation: A. Sole Custody: [ ] Sole Custody of the minor child(ren) awarded to [ ] P etitioner [ ] Respondent, subject to visitation as follows: Visitation: 1. [ ] Reasonable visitation rights to the parent not having custody, as described in a parenting plan attached to this Petition. 2. [ ] Supervised Visitation between the child(ren) and the other party is in the best interests of the child(ren), pursuant to ARS 25 -337 and 25 -338, because : __________________________________________________________________________________________ ___ _____________________________________ _____________________________________________________ ___ __________________________________________________________________________________________ ___ __________________________________________________________________________________________ ___ ___________ _______________________________________________________________________________ ___ Supervised Visitation to the other party not having custody, only in the presence of another person, who is named by the Court upon a finding that supervised visitation is in the best interests of the child(ren). Suggested Supervisor: __________________________________ Requested restrictions on visitation: __________________________________________________________________________________________ ___ __________________________________________________________________________________________ ___ __________________________________________________________________________________________ ___ ____________________________________________________________________ ______________________ ___ __________________________________________________________________________________________ ___ The cost of supervised visitation will be paid for by [ ] Petitioner [ ] Respondent [ ] shared equally. 3. [ ] No visitation ri ghts to the other party. OR B. [ ] Joint Custody: Petitioner and Respondent are to act as a joint custodians of the child(ren), as set forth in the Joint Custody Proposal pursuant to ARS 25 -332 signed by both parties and adopted by the Court. But we n eed to adjust the arrangements according to the Parenting Plan attached to this Petition. There have been no significant acts of Domestic Violence under ARS 13 -3601 by either party. Check below if you are requesting a change of child support in this ca se: ( Remember, even if you do not ask for a change in child support, the Court might Order a change if the Court changes the custody arrangement. ) 2. Child Support: Order that Child Support be paid by the [ ] Petitioner [ ] Respondent in an amount as determined by the Court under the Arizona Child Support Guidelines ( Child Support Order to be attached to the Custody and Visitation Order). Support payments shall begin on the first day of the first month following the entry of the Custody and Visitati on Order. These payments, plus fee for handling, shall be paid through he Clerk of the Court and be collected by automatic wage assignment. 3. Health, Medical, Dental Insurance and Health Care Expenses for Children: Order that the [ ] Petitioner [ ] Re spondent shall pay for health, medical and dental insurance coverage for the children under the age of 18 years, and that [ ] I or [ ] the other party shall pay for all reasonable un reimbursed medical, dental and health -related expenses incurred for the child(ren) in proportion to their respective incomes as described on the the Parent's Worksheet, which shall be submitted with the Judgment and Order. 4. Other Orders that I am Requesting from the Court: _______________________________________________ __________________________________________________________________________________________ ___ __________________________________________________________________________________________ ___ _____________________________________________________________________ _____________________ ___ __________________________________________________________________________________________ ___ OATH AND VERIFICATION STATE OF ARIZONA ) )ss County of ______________ ) I swear under oath, state that I have read this petition and all the statements are true and correct and complete to the best of my knowledge and belief. _____________________________________ Filing Party Subscribed and Sworn before me thi s ________ day of _____________________, 199___. Notary Public ________________________________________________ ( seal )