Affidavit Regarding Minor Children {DRCVG13f}

Name of Person Filing: In this case I am: In this case I am: If Represented by Attorney: My Address (if not protected): City, State, Zip Code: Telephone Numbers: Petitioner Respondent Representing Myself (No Attorney), or Attorney Bar Number: For Clerk's Use Only SUPERIOR COURT OF ARIZONA IN MARICOPA COUNTY Case Number: Name of Petitioner ATLAS Number: (if applicable) Name of Respondent AFFIDAVIT REGARDING MINOR CHILDREN NOTICE: This "Affidavit Regarding Minor Children" is required for all legal decision making (custody) cases. If you are asking to modify an existing Arizona legal decision making order, it is only required if the children have lived outside the state at some time in the last 5 years. (Fill out this Affidavit completely. Provide accurate information. Use additional paper if necessary. You must give copies of this Affidavit and all other required documents to the other party, and to the judge.) 1. CHILDREN OF THE PARTIES WHO ARE UNDER 18 YEARS OLD. The following child(ren) are under age 18 and were born to, or adopted by, me and the other party. Name Birthdate: Name Birthdate: Name Birthdate: Name Birthdate: Age: Age: Age: Age: 2. INFORMATION REGARDING WHERE THE CHILDREN UNDER 18 YEARS OLD HAVE LIVED FOR THE LAST 5 YEARS (or since birth, if younger than 5). Child's Name: Address: City, State: Child's Name: Address: City, State: Child's Name: Address: City, State: Dates: From Lived with: Relationship to Child: Dates: From Lived with: Relationship to Child: Dates: From Lived with: Relationship to Child: To To To Same information about additional children continues on attachment titled "Affidavit re Minor Children continued". © Superior Court of Arizona in Maricopa County ALL RIGHTS RESERVED DRCVG13f-032713 Page 1 of 2 American LegalNet, Inc. www.FormsWorkFlow.com AFC Case No. __________________ 3. COURT CASES IN WHICH I HAVE BEEN A PARTY/WITNESS THAT INVOLVED THE LEGAL DECISION MAKING (CUSTODY) AND/OR PARENTING TIME OF THE MINOR CHILD(REN). (Check one box.) I have or I have not been a party/witness in court in this state or in any other state that involved the legal decision making (custody) and/or parenting time of the child(ren) named above. (If so, explain on separate paper. If not, go on.) Name of each child: Name of Court: Court Case Number: How the child is involved: Summary of any Court Order: Court Location: Current Status: 4. INFORMATION REGARDING PENDING COURT CASES RELATED TO THE LEGAL DECISION-MAKING AUTHORITY (CUSTODY) OF THE MINOR CHILD(REN). (Check one box.) I do have or I do not have information about a legal decision making (custody) court case relating to any of the children named above that is pending in this state or in any other state. (If so, explain. If not, go on.) Name of each child: Name of Court: Court Case Number: How the child is involved: Summary of any Court Order: Court Location: Current Status: 5. LEGAL DECISION-MAKING (CUSTODY) OR PARENTING TIME CLAIMS OF ANY PERSON. (Check one box.) I do know or I do not know a person other than the Petitioner or the Respondent who has physical custody or who claims legal decision-making (custody) or parenting time rights to any of the children named in this Affidavit. (If so, explain below. If not, go on.) Name of each child: Name of person with the claim: Address of person with the claim: Nature of the claim: OATH OR AFFIRMATION AND VERIFICATION I swear or affirm that the information on this document is true and correct under penalty of perjury. Signature Sworn to or Affirmed before me this: (date) My Commission Expires: by Date Deputy Clerk or Notary Public © Superior Court of Arizona in Maricopa County ALL RIGHTS RESERVED DRCVG13f-032713 Page 2 of 2 American LegalNet, Inc. www.FormsWorkFlow.com AFC