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FOR CLERK'S USE ONLY SUPERIOR COURT OF ARIZONA MOHAVE COUNTY ________________________________ Petitioner Case Number:____________________________ JUDGMENT AND ORDER FOR PATERNITY and/or ________________________________ Respondent CHILD SUPPORT LEGAL DECISION MAKING PARENTING TIME VITAL RECORDS (Check this box if any minor child was born in Arizona and the father's name is to be added and/or the minor child's last name is to be changed on the birth certificate.) 1. This case has come before the court for a final Order. If necessary, the court has taken any testimony needed to enter a final Order. This court has jurisdiction over the arties under the law. Where it has the legal power to do so and where it is applicable to the facts of this case, this court has considered, approved, and made an Order relating to paternity, legal decision making, support, parenting time, and expenses related to birth of the minor child(ren) Petitioner and Respondent are the natural parents of the minor child(ren) named on birth certificates as: Middle __________________________ __________________________ __________________________ Last _____________________________ _____________________________ _____________________________ 2. 3. 4. First a._____________________________ b._____________________________ c._____________________________ who were born on this date and at this location (below): (List in same order as above) Month / Day / Year a. ____________________________ b. ____________________________ c. ____________________________ City, State, Nation of Birth _________________________________________________________ _________________________________________________________ _________________________________________________________ 5. PARENT INFORMATION PROGRAM: Petitioner has attended the Parent Information Program class as evidenced by the A. Certificate of Completion in the court file. OR Petitioner has not attended the Parent Information Program class and shall be denied any requested relief to enforce or modify this decree until Petitioner has completed the class. Revised: 1/1/2013 Page 1 of 5 American LegalNet, Inc. www.FormsWorkFlow.com Case No.________________________________ B. Respondent has attended the Parent Information Program class as evidenced by the Certificate of Completion in the court file. OR Respondent has not attended the Parent Information Program class and shall be denied any requested relief to enforce or modify this decree until Respondent has completed the class. 6. DEVIATION FROM CHILD SUPPORT: The court, having considered the best interests of the child(ren), deviates from the guidelines for the following reasons: Application of the guidelines is inappropriate. Application of the guidelines is unjust. The parties have signed a written agreement with knowledge of the amount of support that would have been ordered by the guidelines but for the agreement. The court makes the following finding regarding the deviation: The child support order would have been $____________________ The child support order after deviation is $____________________ All parties have signed the agreement free of duress and coercion. 7. PHYSICAL LEGAL DECISION MAKING ADJUSTMENT, COURT APPROVED DISCRETIONARY PARENTING TIME ADJUSTMENT AND/OR OTHER ADJUSTMENTS: (The court must make written findings if any of these adjustments are made) ______________________________________________________________________________________ ______________________________________________________________________________________ ______________________________________________________________________________________ The court finds that the person responsible for paying child support has the ability to pay child support: in the amount entered on line 33 of the Worksheet for $____________________ in an adjusted amount calculated using the self-support reserve on line 35 of the Worksheet for $____________________ 8. LEGAL DECISION MAKING OF THE MINOR CHILD(REN): (Check and complete only if legal decision making contested or joint legal decision making ordered.) The legal decision order or agreement is in the best interests of the minor child(ren) for the following reasons: (List the reasons.) _________________________________________________________________________________ _________________________________________________________________________________ _________________________________________________________________________________ 9. SUPERVISED OR NO PARENTING TIME: (Check and complete only if supervised or no parenting time is ordered.) Supervised parenting time between the minor child(ren) and Petitioner OR Respondent No parenting time by Petitioner OR Respondent is in the best interests of the minor child(ren), for the following reasons: (Explain the reasons): _________________________________________________________________________________ _________________________________________________________________________________ _________________________________________________________________________________ Revised: 1/1/2013 Page 2 of 5 American LegalNet, Inc. www.FormsWorkFlow.com Case No._______________________________ 10. DOMESTIC VIOLENCE: If the court enters an order for joint legal decision making of the minor child(ren) check box "1" or box "2" and explain. 1. Domestic violence has not occurred during this relationship, OR 2. Domestic violence has occurred, but the domestic violence has not been significant. Explain why joint legal decision making is in the best interest of the minor child(ren) even though domestic violence has occurred: ____________________________________________________________________________ ____________________________________________________________________________ 11. DRUG CONVICTION WITHIN LAST TWELVE MONTHS. (Check, if applicable). If either party has been convicted of driving under the influence of alcohol or drugs, or was convicted of any drug offense within 12 months of filing the request for legal decision making, the legal decision making and/or parenting time arrangement ordered by this court appropriately protects the minor child(ren) THE COURT ORDERS: 1. PATERNITY: (Name of father as on his birth certificate) First _______________________________ Middle __________________________ Last _____________________________ is declared to be the natural father of the minor child(ren). FOR ANY CHILDREN BORN IN THE STATE OF ARIZONA, THE CLERK OF COURT WHALL FORWARD A COPY OF THIS ORDER TO THE OFFIC