Arizona > Local County > Mohave > Superior Court > Paternity
Proposed Paternity Resolution Statement - Arizona
| Proposed Paternity Resolution Statement Form. This is a Arizona form and can be used in Paternity Superior Court Mohave Local County . |
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FOR CLERK'S USE ONLY Name of Person Filing: ___________________________________ Mailing Address: ___________________________________ City, State, Zip Code: ___________________________________ Daytime Phone Number: ___________________________________ Evening Phone Number: ___________________________________ ATLAS Number (if Applicable):_______________________________ State Bar Number (If Applicable):_____________________________ Representing: Self Petitioner Respondent SUPERIOR COURT OF ARIZONA MOHAVE COUNTY _______________________________________ Petitioner/Plaintiff _______________________________________ Respondent/Defendant Case Number ______________________ PROPOSED PATERNITY RESOLUTION STATEMENT OF: FATHER MOTHER The undersigned party provides the following specific positions on each of the issues in this case (BE SPECIFIC): 1. IV-D Case: I receive or have received public assistance that may include AFDC, TANF, or AHCCCS for my children or me. I have a case with the Division of Child Support Enforcement. Custody: The other parent and I have the following natural or adopted children in common: Child(ren)'s Name(s) _________________________________________________ _________________________________________________ _________________________________________________ Date of Birth _______________ _______________ _______________ Age _________ _________ _________ 2. I want the child[ren] to live primarily with Mother OR Mother Father as follows (check all that apply): Father and have parenting time with County Guidelines for reasonable parenting time. In accordance with Every other weekend from: _______________ at _________ a.m. p.m. to _______________ at _________ a.m. p.m. One-half of the holidays on an alternating basis. For ________ weeks in the summer from _______________ to ______________(inclusive). Spring Break from school. Other: ___________________________________________________________________ _________________________________________________________________________ Mother Father Both parents should make the decisions about the child(ren), such as schools, doctors, etc. This should be a sole custody joint custody arrangement. 11/7/06 Page 1 of 3 American LegalNet, Inc. www.FormsWorkflow.com Case No._________________________ 3. Child Support: My position on the financial factors necessary to calculate child support under the statewide child support guidelines is as follows (complete in full): Father's Gross Monthly Income: $________________ Mother's Gross Monthly Income: $________________ Father has _______ other child(ren) not listed above who live(s) in his household. Father has _______ other child(ren) not listed above for whom he pays court-ordered child support in the amount of $ _____________ per month. Mother has _______ other child(ren) not listed above who live(s) in her household. Mother has _______ other child(ren) not listed above for whom she pays court-ordered child support in the amount of $ _____________ per month. Medical Insurance should be paid by Mother Father. The monthly cost for the child(ren) is $ _____________. Monthly Child Care Costs for _______ child[ren] is $ _____________. Extra Education Expenses or Extraordinary Child Adjustments: I believe the court should add the following to the child support calculation (leave blank if none claimed): Description ________________________________________________________ ___________________________________________________________ ___________________________________________________________ Monthly Amount $___________________ $___________________ $___________________ Uninsured Medical Expenses should be paid: Pro rata based upon each party's income as provided in the guidelines; or Other: _______% paid by Father and _______% paid by Mother. Tax Exemptions for the child[ren] should be divided (check one): Pro rata based upon each party's income as provided in the guidelines; or Other: _________________________________________________________________ 4. Past Support should be paid by Mother Father for the period of ____________through __________________ in the amount of $ _____________. Direct payments for support have been received by me paid by me for the period of 5. __________________ through ______________ in the amount of $ _____________. 6. Past Medical Expenses have been incurred by me (and not reimbursed by insurance) for the period of ________________ through ____________ in the amount of $ _____________ and the other parent should be ordered to reimburse me for _______% of those expenses. Expenses for pregnancy, childbirth, and genetic testing have been incurred by me (and not reimbursed by insurance) in the amount of $_____________ and the other parent should be ordered to reimburse me for _______% of those expenses. Attorneys' Fees: If the case is settled today, I want the court to order (choose one): Each party to pay his or her own attorneys' fees and costs. Mother to pay $_____________ of my attorneys' fees and costs within _______ days. Father to pay $_____________ to other party for attorneys' fees and costs within _______ days. 7. 8. 11/7/06 Page 2 of 3 American LegalNet, Inc. www.FormsWorkflow.com Case No.____________________________ 9. Name Change: I want the child(ren)'s names to be changed as follows: ________________________________________________________________________________ ________________________________________________________________________________ Other Issues: Briefly state the other issues that you believe must be resolved to fully settle this case: ________________________________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ Settlement: I verify that the above statements are true upon my best information and belief and I am willing to settle and resolve this case based upon the information provided above. I will be prepared to show documentation to support my position at the time of the conference or hearing. 10. 11. _______________________________ Date ___________________________________________ Signature of Mother Father 11/7/06 Page 3 of 3 American LegalNet, Inc. www.FormsWorkflow.com
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