What You Are Asking For

a. General Information

LEGAL DECISION-MAKING (legal custody) Check this box if you want the court to decide who makes major choices for the child, like health and school. PARENTING TIME Check this box if you want the court to set a schedule for when the child is with each parent.

b. Child Support

CHILD SUPPORT Check this box if you want the court to order one parent to pay money to help support the child. VITAL RECORDS (Check this box if the Department of Vital Records is ordered to change the birth records of a child born in Arizona.) Check this box only if you want the court to order a change to the child's birth record. The child must have been born in Arizona. There are Check this if the mother has unpaid medical costs from giving birth to the child(ren). There are no Check this if there are no unpaid medical costs from the birth. Party A Check this if Party A should pay these birth-related medical costs. Party B Check this if Party B should pay these birth-related medical costs. I have Check this if you already completed the Parent Information Program. I have not Check this if you have not yet completed the Parent Information Program. Domestic Violence has not occurred between the parties. OR Check this if there has been no domestic violence between you and the other party. 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. Check this if there was domestic violence and the person who caused it should not get decision-making power. Domestic Violence has occurred but it was committed by both parties 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) Check this if both parties caused violence, or it is still best for the child(ren) to give decision-making to a parent who caused violence. Explain why below. (EXPLAIN) Explain why giving decision-making power to a parent who caused violence is still best for the child(ren). First Write the father's first name exactly as it appears on his birth certificate or current legal name. Middle Write the father's middle name as shown on his birth certificate or current legal name. Last Write the father's last name as shown on his birth certificate or current legal name. Order that the name of the father listed in “A” above be added to each minor child's birth certificate: Check this box if you want the father's name added to each child's birth certificate. Order each minor child's last name (only) be changed to: Check this box if you only want to change each child's last name. Order each minor child's last name (only) be changed to: Write the new last name you want for the children. OR Order as follows: Check this box if you want a different name change than just the last name. Order as follows: Describe the exact name change you are asking the court to order. Reasonable parenting time rights as described in the Parenting Plan, OR Check this box if both parents will share time with the children as set out in the Parenting Plan. Supervised parenting time between the children and Check this box if one parent should only see the children while another person watches. Party A Check this box if Party A is the parent who needs supervised visits. Party B, Check this box if Party B is the parent who needs supervised visits. No parenting time rights to the Check this box if one parent should have no time with the children at all. Party A Check this box if Party A is the parent who should have no time with the children. Party B. Check this box if Party B is the parent who should have no time with the children. Supervised or no parenting time is in the best interests of the child(ren) because: Explain why supervised visits or no visits are best for the children. Give clear reasons. Explanation continues on attached pages made part of this document by reference. Check this box if you ran out of room and added more pages to finish your explanation. Name this person to supervise: Write the full name of the person who will watch over the visits. Party A Check this box if Party A should pay for the supervised visits. Party B Check this box if Party B should pay for the supervised visits. Shared equally by the parties Check this box if both parents should split the cost of supervised visits evenly. Additionally restrict parenting time as follows: (Explain.) Explain any other limits you want placed on a parent's time with the children. AWARD SOLE LEGAL DECISION-MAKING (sole legal custody) to: Check this box if you want only one parent to make the big decisions for the child, like school and health care. Party A Check this if you want Party A to be the only parent making major decisions. Party B Check this if you want Party B to be the only parent making major decisions. AWARD JOINT LEGAL DECISION MAKING (joint legal custody) to BOTH PARENTS. Check this box if you want both parents to share in making the big decisions for the child. Party A Check this if you are asking the court to order Party A to pay child support. Party B as follows, EITHER: Check this if you are asking the court to order Party B to pay child support. in the amount set forth in the Child Support Worksheet filed with this Petition and incorporated by this reference. Check this if you want the support amount to match the figure from the Child Support Worksheet you filed. in the amount of $ Check this if you want a different amount than the standard guidelines say. in the amount of $ Write the dollar amount of child support you are asking for each month. I am requesting a deviation because: (EXPLAIN) Explain in your own words why the support should be different from the usual amount. Order that past child support for the period stated under #7 above, be paid by Check this if you want the court to order support for a past time period before this case. Party A Check this if you want Party A to pay the past child support. Party B Check this if you want Party B to pay the past child support. Party A Check this if you want Party A to help pay for birth costs the mother was not paid back for. Party B pay a reasonable amount to cover unreimbursed expenses incurred by the mother related to the birth of each child(ren). Check this if you want Party B to help pay for birth costs the mother was not paid back for. Party A should be responsible for providing: Check this if you want Party A to carry insurance for the children. Then mark which types below.

c. Health & Medical Support

medical Check this if Party A should provide medical insurance for the children. dental Check this if Party A should provide dental insurance for the children. vision care insurance. Check this if Party A should provide vision (eye care) insurance for the children. Party B should be responsible for providing: Check this if you want Party B to carry insurance for the children. Then mark which types below. medical Check this if Party B should provide medical insurance for the children. dental Check this if Party B should provide dental insurance for the children. vision care insurance. Check this if Party B should provide vision (eye care) insurance for the children. Order that both parties pay for all reasonable unreimbursed medical, dental, vision care, and health-related expenses incurred for the minor child(ren) in proportion to their respective incomes as described on the Child Support Order, which shall be submitted with the Judgment and Order. Check this if you want both parents to share leftover medical and care costs based on how much each earns. OTHER ORDERS I AM REQUESTING (explain request here): Describe any other orders you want the court to make that were not listed above.