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Name:_________________________________________________ Address:_______________________________________________ City, State. Zip:_________________________________________ Telephone:_____________________________________________ State Bar Code:_________________________________________ Client:_________________________________________________ IN THE SUPERIOR COURT OF THE STATE OF ARIZONA In and for the County of ______________ _____ ___________________________________________ In Re: the Marriage of: CASE NO. ______________________________________, Petitioner PETITION FOR; vs. [ ] DISSOLUTION OF MARRIAGE WITH CHILDREN [ ] DISSOLUTION OF MARRIAGE ______________________________________, WITHOUT CHILDREN Respondent [ ] LEGAL SEPARATION WITH CHILDREN [ ] LEGAL SEPARATION WITHOUT CHILDREN _____________________________________________________________ _____________________DR2DIV THE PETITIONER ALLEGES AS FOLLOWS: 1. I am or my spouse is domiciled or stationed while a member of the armed forces in Arizona, and in either case the domicile or military presence has been maintained for 90 ( ninety ) days immediately prior to filing this Petition. The Court has jurisdictio n under ARS 25 -331 and 8 -401 et seq. to decide child custody matters. 1. [ ] That this marriage is irretrievably broken and there is no reasonable prospect for reconciliation or ; [ ] That one or both parties desire to live separate and apart. Conciliation proceedings [ ] have been [ ] have not been filed. 3A. Petitioner's full name is ____________________________________________________________________ Petitioner's present mailing address is ____________________________________________________ _____ ____________________________________________________________________________________ _ Petitioner's birth date is ____________________________________________________________________ Petitioner is currently employed as ____________________________ _______________________________ Petitioner has resided in the State of Arizona for ________ years. 3B. Respondent's full name is __________________________________________________________________ Respondent's present mailing address is _________________ ___________________________________ ____________________________________________________________________________________ ___ Respondent's birth date is __________________________________________________________________ Respondent is currently employed as _________________________________________________________ [ ] Respondent has resided in the State of Arizona for _______ years. [ ] Respondent is a resident of the State of ___________________________ and has been for _______ years. 4. Parties were married on ______________________________, 19____, in the City of __________________ ___________________, County of ____________________, State of _______________________________ AFFIDAVIT RE: MINOR CHILDREN 4. A child(ren), was born or adopted during the marital relationship ( list the name, age, DOB, and birthplace for each child ): A ____________________________________________________________________________________ B ____________________________________________________________________________________ C ________________________________________________________________________________ ____ D ____________________________________________________________________________________ E ____________________________________________________________________________________ The child(ren) is/are currently residing with the [ ] Petitioner [ ] Respo ndent, at the addresses listed in paragraph #_______, above. 6. The minor child(ren) has / have resided at the following addresses, with the listed part(ies) for the past 5 (five) years: A _______________________________________________________________ _____________________ B ____________________________________________________________________________________ C ____________________________________________________________________________________ 7A. I [ ] have [ ] have not been a party, witness, etc., in a legal action regarding the child(ren) named above in this or any other State. ( If so, state the name(s), of the child(ren) involved, capacity, Court, State, case no, and the Date of the Order or Judgment. ) 7B. I [ ] do [ ] do not have informatio n of a custody matter relating to the child(ren) named above in a Court of this or any other State. ( If so, state the person's name, and address, status of custody [ whether physical ], who asserts custody rights or visitation rights, and the names of the children involved. ) 7C. I [ ] do [ ] do not have information as to anyone unrelated to this matter having custody [physical], or asserts to have custody or visitation rights, regarding any child(ren) named above. ( If so, give name and address of the person(s), custody status, asserting custody rights and name(s) of children involved. ) 8. [ ] I certify that I ( or my wife, if the wife is not the Petitioner ) am not pregnant. If pregnant, I certify that the unborn child [ ] is [ ] is not common to the parties. The unborn child is due :___________________________________,19_______. 9. [ ] There is no Spousal Maintenance requested. [ ] It is requested that Spousal Maintenance be paid by [ ] Petitioner [ ] Respondent in the amount of $___________._____ per _______________, commencing on _________________, 19____, and continuing on the same date until __________________, 19____, unless terminated sooner by remarriage, the death of either spouse, or by further Order of this Court. Spousal Maintenance payments shall be made through the Clerk of the Court in the manner prescribed by law, a nd shall include the fees required under ARS 11 -554(A) (ii). Payor may deduct all amounts paid as Spousal Maintenance from his or her income in computation of both State and Federal Income Taxes. 10. Information pertaining to the support, custody and visita tion of children, maintenance of a spouse, and division of existing community property and / or community debts is: [ ] Set forth below, or; [ ] Set forth in the attached agreement, or; [ ] Other ( describe ) :______________________________________________________________________ 11. In regard to the custody of the minor child(ren), it is requested that this Court award the care, custody, and control of the minor child(ren) of the part ies to: [ ] Petitioner [ ] Respondent or; [ ] Both parties jointly. In requesting an award of joint custody, Petitioner states that the parties can sustain an ongoing commitment to the child(ren), that joint custody is logistically pos sible, and that neither party, as a granting or withholding his agreement, was influenced by duress or coercion with respect to any factors before the Court. The child(ren) shall reside primarily with the [ ] Petitioner [ ] Respondent, who will also be aw arded child support in a reasonable amount as determined by current Arizona Child Support Guidelines. Said support shall commence on the date of the final Decree of Dissolution, and continue thereafter on the same date of each month, unless otherwise stip ulated by the Court; until each child turns the age of 18, unless the child turns the age of 18 during a high school year in which case the child support shall continue until June of that year; marries; is deceased; or becomes emancipated; and there is no special support payments. Child Support payments, plus any fee for handling, shall be paid through the Clerk of this Court, and shall be collected through automatic Wage Assignment. 12. Award visitation rights to the non -custodial parent, the [ ] Petitioner [ ] Respondent , according to: [ ] Guidelines in the separate Settlement Agreement, included, or; [ ] The following schedule, formula, or guidelines:_______________________________________________ ____________________________________________________________________________________ ______ ___ __________________________________________________________________________________________ ___ __________________________________________________________________________________________ ___ __________________________________________________________ ________________________________ ___ [ ] Visitation during holidays and school breaks will be granted as follows:__________________________________ __________________________________________________________________________________________ ___ __________________________________________________________________________________________ ___ __________________________________________________________________________________________ ___ ____________________________________________________________________ ______________________ ___ [ ] Extended visitation will be granted as follows: _____________________________________________________ __________________________________________________________________________________________ ___ ______________________________ ____________________________________________________________ ___ __________________________________________________________________________________________ ___ __________________________________________________________________________________________ ___ [ ] Telephone visitation will be granted as follows: _____________________________________________________ __________________________________________________________________________________________ ___ ___________________________________________________________ _______________________________ ___ [ ] Non -custodial party will be allowed supervised visitation only in the presence of a third party approved by the Court or the Petitioner. [ ] Non -custodial party is not granted visitation for reasons stated in an attac hed explanation. [ ] The minor child may deny or reschedule visitation. [ ] Additional pages attached 12. In regard to the current medical and dental coverage for the minor child(ren): A. [ ] Currently, as well as in the foreseeable future, medical and dental coverage on behalf of the minor child(ren) will be paid for by the _____ Petitioner _____ Respondent. B. [ ] Health care expenses not covered by insurance shall be paid for by the [ ] Petitioner [ ] Respondent . C. [ ] Currently, medical and denta l coverage on behalf of the minor child(ren) will be provided by the Arizona Health Care Cost Containment System ( AHCCCS ). The same will continue until [ ] the Court modifies the same, or until [ ] Petitioner [ ] Respondent is able to obtain same throug h employment, at which time said party shall obtain same to cover the minor child(ren). D. [ ] Currently the medical and dental coverage on behalf of the minor child(ren) will be provided as follows: _______________________________________________________ ___________________________________ ___ __________________________________________________________________________________________ ___ E. [ ] There is the following further information in regard to the medical and dental coverage on behalf of the minor chil d(ren): _______________________________________________________________________________ __________________________________________________________________________________________ ___ F. [ ] Award to [ ] Petitioner [ ] Respondent the household furniture and/or furnishings necessary for the minor child(ren). [ ] A Restraining Order [ ] is [ ] is not needed. 12. Parties shall claim tax exemptions on the minor child(ren) as outlined b elow ( one tax exemption per child). The parent claiming a child as an exemption shall receive an Affidavit of Waiver of Exemption Rights from the non -claiming parent by January 31, of each year to be filed with the tax forms of the parent claiming exempt ion. 12. [ ] Neither of the parties shall remove any of the minor child(ren) from the State of Arizona for more than a period in excess of 14 ( fourteen ) days consecutively without written consent of the other, or without a Court Order. 12. [ ] There are no further provisions concerning the minor child(ren) of the parties [ ] There are further provisions concerning the minor child(ren) of the parties as follows:_________________ _____________________________________________________________________ _____________________ ___ __________________________________________________________________________________________ ___ __________________________________________________________________________________________ ___ ___________________________________________ _______________________________________________ ___ 12. Petitioner should be awarded the following as his or her sole, separate, and legal property: A. [ ] Real Estate ( legally described as ) : _____________________________________________________ _____ _____________________________________________________________________________________ ___ __________________________________________________________________________________________ ___ B. [ ] Other Property ( describe ) : ___________________________________ ________________________ __________________________________________________________________________________________ ___ __________________________________________________________________________________________ ___ C. [ ] Pension / Retirement Fund / Profit Sharing / Stock Plan: _____________________________________ __________________________________________________________________________________________ ___ ____________________________________________________________ ______________________________ ___ __________________________________________________________________________________________ ___ [ ] Petitioner will waive all present and all future claims to any and all accrued retirement benefits due to the other party f rom the employer(s) designated as follows :________________________________________________ __________________________________________________________________________________________ ___ D. [ ] Income Tax Refund $ __________________ ( amount ) E. [ ] Li fe Insurance _____________________________________________________________________ __________________________________________________________________________________________ ___ F. [ ] Motor Vehicles ( year, make, model, and VIN. no. ) : __________________ __________________ __________________________________________________________________________________________ ___ __________________________________________________________________________________________ ___ G. [ ] Household Furniture [ ] List included H. [ ] Household Furnishings [ ] List included 12. Petitioner should be ordered to pay and hold Respondent harmless from the following community debts (name of Creditor and balance due ) : _________________________________________________________ ________ __________________________________________________________________________________ ___ __________________________________________________________________________________________ __ _____________________________________________________________________________ _____________ ___ __________________________________________________________________________________________ ___ 12. Respondent should be awarded the following as his or her sole, separate, and legal property: A. [ ] Real Estate ( legally described as ) : _____________________________________________________ __________________________________________________________________________________________ ___ ______________________________________________________________ ____________________________ ___ B. [ ]Other Property ( describe )_____________________________________________________________ __________________________________________________________________________________________ ___ __________________________________ ________________________________________________________ ___ C. [ ] Pension / Retirement Fund / Profit Sharing / Stock Plan: _________________________________ __________________________________________________________________________________________ ___ ___ _______________________________________________________________________________________ ___ __________________________________________________________________________________________ ___ [ ] Respondent will waive all present and all future claims to any and all accrued retirement benefits due to the other party from the employer(s) designated as follows :_____________________________________________ __________________________________________________________________________________________ ___ D. [ ] Income T ax Refund $ __________________ ( amount ) E. [ ] Life Insurance ______________________________________________________________________ __________________________________________________________________________________________ ___ F. [ ] Motor Vehicles ( year, make, model, and VIN. no. ) :________________________________________ __________________________________________________________________________________________ ___ _____________________________________________________________________________________ _____ ___ G. [ ] Household Furniture [ ] List included H. [ ] Household Furnishings [ ] List included 12. Respondent should be ordered to pay and hold Petitioner harmless from the following community debts (name of Creditor and balance due ) : _________ ________________________________________________ __________________________________________________________________________________________ ___ __________________________________________________________________________________________ ___ __________________________________________________________________________________________ ___ WHEREFORE, Petitioner requests that the Court Order the following: 12. [ ] Decree of Dissolution of Marriage [ ] Decree of Legal Separation 12. Order that the community property rights and liabilities acquired by the marriage terminate as to all property, income, and liabilities received or incurred after the entry of a Decree of Legal Separation, ARS 25 -313 (B). [ ] Order that the community property rights and liabiliti es acquired by the marriage not terminate as to all property, income, and liabilities received or incurred after the entry of a Decree of Separation, ARS 25 -313 (B). 12. [ ] Restore Wife to her former name of : ____________________________________________ __________ Wife's Signature: _________________________________________________________________________ Wife's current legal name, before change ( please print ) :__________________________________________ 12. Award the care, custody, including the resid ential, physical custody, and control of the minor child(ren) to [ ] Petitioner [ ] Respondent [ ] Both parties, jointly. 13. Award the residential custodial parent reasonable Child Support pursuant to current Arizona Child Support Guidelines. Said Suppo rt shall commence on the date of the final Decree of Dissolution. Support payments, plus fees for handling, are to be paid through the Clerk of this Court, and to be collected by Automatic Wage Assignment. 12. Award visitation rights to the non -custodial parent, the [ ] Petitioner, [ ] Respondent, according to the schedule, guidelines, formula, or other, as specified above. 12. [ ] Award Spousal Maintenance to, in an amount and for such time as is determined by this Court, to: [ ] Petitioner [ ] Respon dent 12. [ ] Award community property as specified above. 12. [ ] Allocate community debts as specified above. 12. [ ] Order Respondent to pay any and all community debts unknown to Petitioner [ ] and each party shall be Ordered to pay and leave the o ther party harmless from his/her debts incurred since the parties' separation on ____________________________________. 12. [ ] Award to [ ] Petitioner [ ] Respondent the household furniture and/or furnishings necessary for the party and for the minor child(ren). 12. [ ] Assign each party his or her sole, separate, and legal property. 12. [ ] Order that [ ] Petitioner [ ] Respondent waive all rights to the accrued retirement benefits due to the other party from the employer(s) listed above. 12. [ ] Order that each party waives any and all right to inherit the estate of the other at their death or to take property from the other by devise or bequest, unless under a Will properly executed after the date of this Agreement. 12. [ ] There is no further relief requested. [ ] The following further relief is requested : I have read the foregoing Petition and know of my own knowledge that the facts stated therein are true and correct. ___________________________________ Petitio ner STATE OF ARIZONA ) )ss County of _______________ ) SUBSCRIBED AND SWORN before me this date: ______________________ Notary Public ______________________________________ ( Seal )