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:
Petitioner / Party A
ATLAS Number:
(if applicable )
PETITION FOR DISSOLUTION OF A
NON- COVENANT MARRIAGE (DIVORCE)
WITH MINOR CHILDREN
Respondent / Party B
STATEMENTS THE COURT, UNDER OATH OR AFFIRMATION:
1. INFORMATION ABOUT ME :
Name:
Address :
Date of Birth :
Job Title:
I have liv ed in Arizona for ____ years and/or ____ months
2. INFORMATION ABOUT MY SPOUSE:
Name:
Address :
Date of Birth :
Job Title:
My spouse has lived in Arizona for ____ years and/or ____ months
3. INFORMATION ABOUT OUR MARRIAGE:
Date of Marriage:
City and state, or country where we were married:
The following statements MUST BE TRUE for you to use this document and to qualify for divorce in Arizona
AND you must check the boxes to indicate that the statements are true or your case may not proceed.
We do not have a covenant marriage (If not sure, refer to the INSTRUCTIONS for information).
Our marriage is broken beyond repair (“irretrievably broken”) and there is no hope of reconciliation.
We have tried to resolve our problems through Conciliation Services or going to Conciliation
Services would not work.
This court has jurisdiction to determine parenting time (physical custody) and authority for legal
decision -making (le gal custody) over our minor child(ren) common to the parties because the
minor child(ren) has/have lived with Party A or Party B in Arizona for at least the past 6 months.
FOR CLERK’S USE ONLY
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4. 90 DAY REQUIREMENT: (This statement MUST be true before you can file for divorc e in Arizona.)
I OR my spouse have lived in Arizona or have been stationed in Arizona while a member of the
Armed Forces, for at least 90 days before I filed this action.
5. DOMESTIC VIOLENCE: (If you intend to ask for joint legal decision- making authority (joint legal
custody) , there must have been no significant domestic violence in your marriage. A.R.S. 25- 403.03. Check
the box to make a true statement:
S ignificant domestic violence has or has not occurred during this marriage.
6. CHILDREN OF THE PARTIES WHO ARE LESS THAN 18 YEARS OLD:
There are no children under the age of 18 either born to, or adopted by, Party A or Party B .
Listed below are children still under the age of 18 born to or adopted by my spouse and me during our
marriage, or where indicated, born before the marriage.
Child’s Name:
Birthdate: Born prior to marriage
Address:
Length of Time at Address:
Child’s Name:
Birthdate: Born prior to marriage
Address:
Length of Time at Address:
Child’s Name:
Birthdate: Born prior to marriage
Address:
Length of Time at Address:
Child’s Name:
Birthdate: Born prior to marriage
Address:
Length of Time at Address:
Child’s Name:
Birthdate: Born prior to marriage
Address:
Length of Time at Address:
7. PREGNANCY and PATERNITY: (Check one box .)
Party A IS NOT pregnant, OR Party B IS NOT pregnant, OR
Party A IS pregnant , OR Party B IS pregnant
The baby is due on (date), (and, check one box below):
Party A and Party B ARE the parents of the child, OR
Party A or Party B IS NOT the parent of the child, OR
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A minor child or minor children were born before the marriage.
Party A and/or Party B is /are the parent (s) of that minor child/those minor children named
below:
8. INFORMATION ABOUT PROPERTY AND DEBTS
WARNING: You must be specific. You must describe the property that should go to you,
and then check the box, and describe the property that should go to your spouse, and check the box.
For example, under household furnishings you could say, blue and white living room sofa, and
then check the box to say whether it should go to Party A or to Party B . Never list an item and then
check both Party A and Party B boxes.
8.a. COMMUNITY PROPERTY: (Property acquired during the marriage)
(Check the proper boxes.)
Party A and Party B did not acquire any community property during the marriage, OR
Party A and Party B acquired community property during our marriage, and we should divide it as
follows:
Party A Party B Value
Real estate located at:
$
Legal Description: (Quote from the DEED)
Party A Party B Value
Real estate located at:
$
Legal Description: (Quote from the DEED)
Household furniture and appliances: Party A Party B Value
$
$
$
$
$
House hold furnishings: Party A Party B Value
$
$
$
$
$
$
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Other items: Party A Party B Value
$
$
$
$
Pensio n/retirement fund/profit sharing/stock plan/401K:
Party A Party B Value
$
$
$
$
Motor vehicles: Party A Party B Value
Make Year: $
Model
VIN _______________________
Lien Holder_____________________
Party A Party B Value
Make Year: $
Model
VIN
Lien Holder
8.b. SEPARATE PROPERTY: (Check all boxes that apply.)
Party A does not have any separate property.
Party B does not have any separ ate property.
Party A has separate property that was brought into this marriage. Award this property to Party A as
described below.
Party B has separate property that was brought into this marriage. Award this propert y to Party B as
described below.
Separate Property: ( List the property and the value of the property, and check the box to tell the
Court who should get the property.)
Description of Separate Property Party A Party B Value
$
$
$
$
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8.c. COMMUNITY DEBTS : (Debt acquired during the marriage) (C heck the proper box es)
Party A and Party B did not incur any community debts during the marriage, OR
Party A and Party B should divide the responsibility for the debts incurred during the marriage as
follows:
DESCRIPTION OF DEBT Party A Party B Amount Owed
$
$
$
$
$
$
8.d. SEPARATE DEBTS: (Check all boxes that apply.)
Party A an d Party B do not have any debts that were incurred prior to the marriage or separate debt;
Party A has separate debt or debt incurred prior to the marriage that should be paid by Party A as
described below;
Party B h as separate debt or debt that Party B incurred prior to the marriage that should be paid by
Party B as described below.
DESCRIPTION OF DEBT Party A Party B Amount Owed
$
$
$
9. TAX RETURNS: (Check this box if this is what you want).
After the Judge or C ommissioner signs the Decree of Dissolution of Marriage (Divorce), we will,
subject to IRS Rules and Regulations, pay federal and state taxes as follows : For the calendar
year (the year that the Decree is signed) and all future calendar years, each party will, subject to IRS
Rules and Regulations, file separate federal and state income tax returns. Each party will give the
other party all necessary documentation to do so.
For previous years (the years we were married, not including the year the Decree was signed), (check
one box)
The parties will file joint federal and state income tax returns. For previous calendar years, both
parties will pay, and hold the other harmless from , 1/2 of all additional income taxes if any and other
costs and each will share equally in any refunds. OR
The parties will file separate federal and state income tax returns. For previous calendar years,
each party will pay and hold the other harmless from any income taxes and/or incurred as a result
of the filing of that party’s tax return and each party will be awarded 100% of any refund received
as a result of the filing of that party’s tax return.
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10. SPOUSAL MAINTENANCE/SUPPORT (ALIMONY) (check the box that applies to you):
Neither party is entitled to spousal maintenance/support (alimony), OR
Party A OR Party B is entitled to spousal maintenance/support because: (Check one or more
of the box(es) on the next page that apply. At least one reason must apply to get spousal
maintenance / support.)
Person lacks sufficient property to provide for his/her reasonable needs;
Person is unable to support himself/herself through appropriate employment;
Person is the custodian of a child(ren) whose age or condition is such that the person should
not be required to seek employment outside the home;
Person lacks earning ability in the labor market adequate to support himself/herself; and
Person contributed to the educational opportunities of the other spouse or had a marriage of
long duration and is now of an age that precludes the possibility of gaining employment
adequate to support himself/herself.
11. WRITTEN AGREEMENT: (Check box only if true. )
Party A and Party B have a written agreement signed by both of us about the maintenance of a
spouse, division of property/debt, where the children will live, legal decision-making (legal custody),
parenting time, and child support, and I have attached a copy of the written agreement.
OTHER STATEMENTS TO THE COURT
12. THE PARENT INFORMATION PROGRAM is required for persons seeking legal decision- making
( legal custody) or parenting time. (Check one box.)
I have have no t already completed the Parenting Information Program.
13. DOMESTIC VIOLENCE. (If you intend to ask for joint legal decision- making (joint legal custody), check
one box.)
Domestic Violence has not occurred in this relationship.
There has been domestic violence in this relationship and no legal decision- making (legal custody)
should be awarded to the party who committed the violence.
Domestic Violence has occurred but it was committed by both par ties 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
legal custody) to a parent who has committed domestic violence because: (Explain.)
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14. DRUG / ALCOHOL CONVICTION WITHIN LAST TWELVE MONTHS: (If you intend to ask for
joint legal decision- making (joint legal custody), check one box.)
Neither party has been convicted for a drug offense or driving under the influence of drugs or
alcohol in the last twelve (12) months,
One or both parties have been convicted for a drug offense or driving under the influence of drugs
or alcohol in the last twelve (12) months.
Party A w as convicted. Party B was convicted.
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 minor child(ren).
15. CHILD SUPPORT.
There is an Order for Child Support, dated
from (name of court)
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 (legal custody), and parenting time.
Party A Party B made voluntary / direct support payments th at 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 this petition was filed and the date current child support is ordered.
16. 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.
REQUESTS TO THE COURT:
A. DISSOLUTION (DIVORCE):
Dissolve our marriage and return each party to the status of a single person;
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RESTORE NAME:
I took the name of my spouse at the time of marriage and I want to restore my last name to the name I
used before this marriage or to my maiden name. My complete married name is:
I want my name restored to: (List complete maiden or legal name before this marriage):
WARNING: If you are not the person who is requesting to have your former name restored, the court must
have a written request from the party who wants his or her name restored to change the name.
B. PATERNITY and MINOR CHILD(REN)’S NAMES: Declare Party A or Party B to be a
legal parent of the following named minor child(ren) born before the marriage and (optional) change the legal
name of those minor children to the name listed on the right, below :
Current Legal Name (OPTIONAL) Change the name of the child to:
C. PRIMARY RESIDENCE , PARENTING TIME, AND AUTHORITY FOR LEGAL DECISION-
MAKING
( LEGAL CUSTODY) :
C. 1. PRIMARY RESIDENCE : Declare the “Primary Residen ce” for each minor child as follows:
Declare Party A’s home as the primary residence for the following named childr en:
Declare Party B’s home as the primary residence for the following named children:
C.2. PARENTING TIME: Award parenting time as follows:
Reasonable parenting time rights to the non- primary residential parent, OR
Supervised parenting time between the children and, Party A or Party B OR
No parenting time rights to 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 t ime as follows:
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c. Order cost of supervised parenting time (if applicable) to be paid by:
Party A
Party B , OR
Shared equally by the parties.
C.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 or Party B
OR
AWARD JOINT LEGAL DECISION- MAKING AUTHORITY to BOTH PARENTS.
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 the 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)
D. CHILD SUPPORT:
1. Order that child support will be paid by: Party A OR Party B in a reasonable amount as
determined by the court under the Arizona Child Support Guidelines.
• Support payments will begin on the first day of the first month after the Judge or Commissioner signs
the Decree; with all the payments, plus the statutory handling fee to be paid through the Support
Payment Clearinghouse, PO Box 52107, Phoenix, Arizona 85072- 7107 by income withholding order.
2. Order that past child support be paid by Party A OR 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 suppor t that has been paid. Support to be paid as defined above.
The Child Support Order to be attached to the Decree of Dissolution of Marriage.
E. MEDICAL, DENTAL, VISION CARE FOR MINOR CHILDREN: Order that
Party A is responsible for providing: medical dental vision care insurance.
Party B is responsible for providing: medical dental vision care insurance.
Party A and Party B will pay for all reasonable unreimbursed medical, dental, and health- related expenses
incurred for the child(ren) in proportion to their respective incomes.
F. 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.
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G. SPOUSAL MAINTENANCE (ALIMONY):
Do not order Spousal maintenance
Order spousal support to be paid by Party A or Party B in the amount of per
month beginning with the first day of the month after the Judicial Officer signs the Decree and continuing
until the person receiving spousal maintenance remarries or either party is deceased, or for a period of
months. These payments, and a fee for handling, will be paid through the Support Payment
Clearinghouse, P O Box 52107, P hoenix, Arizona 85072- 7107 by income withholding order .
H. COMM
UNITY PROPERTY:
Make a fair division of all community property as requested in this Petition.
I. COMM
UNITY DEBTS:
Order each party to pay community debts as requested in the Petition, and to pay
any other community debts unknown to the other party. Order each party to pay and hold the other party
harmless from debts incurred by Party A or Party B:
since the parties
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