Petition To Establish Child Support {DRES11F}

Person Filing: Address (if not protected): City, State, Zip Code: Daytime Telephone Numbers: Email Address: ATLAS Number: Representing [ ] Self or [ ] Lawyer for Lawyer Bar Number: FOR CLERK'S USE ONLY SUPERIOR COURT OF ARIZONA IN COUNTY Case Number: Petitioner PETITION TO ESTABLISH CHILD SUPPORT Respondent STATEMENTS TO THE COURT. 1. INFORMATION ABOUT ME, THE PETITIONER. Name: Address: County of Residence: Date of Birth: Occupation: My relationship to the child(ren) for whom I want a child support order: [] I am the Mother [] I am the Father [] Other: (Explain) INFORMATION ABOUT OTHER PARTY, THE RESPONDENT. Name: Address: County of Residence: Date of Birth: Occupation: 2. Arizona Supreme Court Page 1 of 5 American LegalNet, Inc. www.FormsWorkFlow.com DRES11f-120716 Case Number: Respondent's relationship to the child(ren) for whom I want a child support order: [] Respondent is the Mother [] Respondent is the Father [] Other: (Explain) 3. [] VENUE. This is the proper court to bring this lawsuit under Arizona law because it is the county of residence of the petitioner, or the respondent, or the minor child(ren). 4. JURISDICTION. This Court has jurisdiction under A.R.S. §25-502 to order a party to pay child support because: [] [] [] [] [] [] The Respondent is a resident of Arizona I believe that I will personally serve the Respondent in Arizona The Respondent agrees to have the case heard here and will file written papers in the court case The Respondent lived with the minor child(ren) in this state at some time The Respondent lived in this state and provided pre-birth expenses or support for the minor child(ren) The minor child(ren) lives in this state as a result of the acts or directions of the Respondent 5. INFORMATION ABOUT MINOR CHILD(REN). A. Child's Name: Current Address: City, State: How long at this address: Child's Name: Current Address: City, State: How long at this address: Child's Name: Current Address: City, State: How long at this address: Date of Birth: County: Date of Birth: B. County: Date of Birth: C. County: Arizona Supreme Court Page 2 of 5 American LegalNet, Inc. www.FormsWorkFlow.com DRES11f-120716 Case Number: D. Child's Name: Date of Birth: Current Address: City, State: How long at this address: County: Continues on attached page(s) made part of this document by reference. [] 6. PATERNITY. Paternity was established by: (Check one box.) [] A court Order for Paternity from this county or previously transferred to this county stating that is the natural father of the minor child(ren) included in this Petition. (A.R.S. § 25-502(c)) Both parents signing an Acknowledgment of Paternity through the Hospital Paternity Program or other means provided by law after July 18, 1996, and a birth certificate listing the name of the father was issued as a result. Parties were legally married when child(ren) was (were) born, conceived, or adopted. [] [] 7. CHILD SUPPORT FOR MINOR CHILD(REN). (Check one box.) [] 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 (custody), and parenting time. [] [ ] Petitioner [ ] Respondent made voluntary / direct support payments that need to be taken into account, if past support is requested. [ ] Petitioner [ ] Respondent owes past support for the period between: [] OR [] the date this petition was filed and the date current child support is ordered. 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. [] Arizona Supreme Court Page 3 of 5 DRES11f-120716 American LegalNet, Inc. www.FormsWorkFlow.com Case Number: REQUESTS OF THE COURT. A. CHILD SUPPORT. [] Order that child support be paid by [ ] Petitioner [ ] Respondent in an amount as determined by the court under the Arizona Child Support Guidelines. Support payments to begin on the first day of the month after the Judge or Commissioner signs the Paternity Order with all payments, plus the statutory handling fee, to be paid through the Support Payment Clearinghouse, PO Box 52107, Phoenix, Arizona 850727107 by income withholding order. [] Order that past child support be paid by [ ] Petitioner [ ] Respondent 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 support that has been paid. Support to be paid as defined above. B. MEDICAL, DENTAL, VISION INSURANCE AND HEALTH CARE FOR THE MINOR CHILD(REN). Order that: [] Petitioner should be responsible for providing [ ] medical [ ] dental [ ] vision care insurance. Respondent should be responsible for providing [ ] medical [ ] dental [ ] vision care insurance. Petitioner and Respondent will share all reasonable unreimbursed medical, dental, vision care, and health-related expenses incurred for the minor child(ren)in proportion to their respective incomes. [] [] C. D. Order payment of costs and attorney fees, if appropriate. Order such other relief as deemed necessary and appropriate by the court. Arizona Supreme Court Page 4 of 5 DRES11f-120716 American LegalNet, Inc. www.FormsWorkFlow.com Case Number: UNDER OATH OR AFFIRMATION. I swear or affirm under penalty of perjury that the contents of this document are true and correct to the best of my knowledge and belief. Date STATE OF COUNTY OF Sworn to or Affirmed before me this by Petitioner's Signature (date) . (notary seal) Deputy Clerk or Notary Public Arizona Supreme Court Page 5 of 5 DRES11f-120716 American LegalNet, Inc. www.FormsWorkFlow.com