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Free Arizona Petition Form for Divorce with Children - PDF Form Download

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Use this template/form as a Petition Form for Divorce with Children in the State of Arizona


arizona-petition-form-for-divorce-with-children

Text version of this Form

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DIVORCE
WITH CHILDREN
PETITION

Packet #2

Separate forms from
packet before filing

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PIMA COUNTY SUPERIOR COURT
SELF-SERVICE PACKET

DIVORCE WITH CHILDREN

GENERAL INFORMATION ABOUT
FILING FOR DIVORCE WITH CHILDREN

USE AND DISCLAIMER

These forms shall not be used to engage in the unauthorized practice of law. The court assumes no responsibility
and accepts no liability for actions taken by the users of these forms or in reliance upon the instructions or
information provided.

Court cases can be very complicated, and even if you are representing yourself you should see a lawyer for legal
advice as to how the law applies to you, and what is best in your particular situation. This might save you time,
money, trips to the courthouse, and avoid serious mistakes. There are lawyers who will help you help yourself. This
means that they will only charge you for giving you the help you need, and you can complete the court papers on
your own or ask the lawyer for help with your papers.

There are professional mediators in the community who can help you with your problems. They help you solve your
present problem, and anticipate future problems and how to solve them. Mediators work with both parties in a
dispute to help resolve areas of disagreement or trouble.

A list of individuals, agencies and other resources available to help people resolve legal problems is available at the
Self-Service Center.

HOW TO ASSEMBLE THESE DOCUMENTS

This packet contains general information, instructions and court forms to complete and file, including the divorce
Petition and other court papers. Be sure the documents are in the following order. Look at the lower right-hand
corner of the document for the document number. Documents that end with “info” are instructions and/or general
information. Documents that end with “form” are court forms that MUST be completed and filed with the court.

Title Form Name
Use and Disclaimer (1 page) dwcpetition-use and disclaimer.info
Read this First … Sensitive Data Dwcpetition-read this first.info
Introduction: Getting a Divorce is a Step-by-Step Process (1 page) dwcpetition-introduction.info
Instructions on Filing Out Forms (7 pages) dwcpetition-instructions.info
Domestic Relations Cover Sheet (1 page) dwcpetitIon-domestic cover sheet.form
Summons (1 page) dwcpetition-summons.form
Preliminary Injunction (3 pages) dwcpetition-preliminary injunction.form
Petition for Dissolution of Marriage (With Children) (7 pages) dwcpetition-dissolution of marriage.form
Notice of Right to Convert Health Insurance (1 page) dwcpetition-notice re health insurance.info
Affidavit: Re: Minor Children (2 pages) dwcpetition-affidavit re minor children.form
Sensitive Information Sheet (1 page) dwcpetition-sensitive information.form
Creditor Notification (1 page) dwcpetition-creditor notification.info
Instructions on Filing Papers (1 page) dwcpetition-instructions for filing.info
Request for Protected Address dwcpetiton-request for protected address
Order for Protected Address dwcpetiton-order for protected address

1 dwcpetition-use and disclaimer.info
Revised 07.23.09

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READ THIS FIRST, BEFORE YOU
COMPLETE ANY FORMS IN YOUR PACKET

MOST COURT FILES ARE OPEN TO THE PUBLIC FOR REVIEW, EITHER PERSONALLY OR
ELECTRONICALLY.

Pursuant to Rule 43(G), Arizona Rules of Family Law Procedure, effective January 1, 2006,
before filing any paper containing sensitive data with the court, the filing party shall omit or
otherwise redact the sensitive data unless they are specifically requested by the court. If the
sensitive data are specifically requested by the court, the filer shall record the requested
information on a separate sensitive data form which shall be maintained by the clerk as a
confidential record. You are ENCOURAGED to use the attached form whenever
‘CONFIDENTIAL SENSITIVE DATA” is requested in paperwork, rather than list that information in
the documents filed with the Court that will be available for public scrutiny. The Confidential
Sensitive Data Form(s) in your case will be maintained electronically and sealed and may be
viewed only the Court and court staff, the parties to the case and their attorneys, and Clerk’s
Office staff, except as may be otherwise ordered by the Court.

DEFINITION: “SENSITIVE DATA” includes the following:
A) Social Security number
B) Bank account number, credit card number, or other financial account
numbers

Instructions for form use: Wherever “sensitive data” is required in a document that will be filed
with the Court, write in ‘SEE CONFIDENTIAL SENSITIVE DATA FORM.” Make sure you write in
the appropriate “sensitive data” on the Confidential Sensitive Data Form. Whenever new
information is needed to supplement the record in a case, a party should file with the Clerk’s
Office an updated sensitive data form (including all previously disclosed sensitive data, plus any
additional sensitive data required to be filed in the case.)

ANY PARTY WHO INCLUDES “SENSITIVE DATA” IN DOCUMENTS FILED WITH THE
COURT, OTHER THAN ON A CONFIDENTIAL SENSITIVE DATA FORM, DOES SO AT THAT
PARTY’S OWN RISK.

Dwcpetition-read this first.info
Revised 7.23.2009

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INTRODUCTION: Getting a Divorce is a step-by-step process.

Step 1 Filing for a Fee Deferral/Waiver – The court charges fees to file for a divorce. If you are unable to afford court
fees and some of the other costs involved in obtaining a divorce, you may be eligible to receive a deferral or
waiver of these fees/costs. A deferral means that you can pay your fees/costs either in installments over a
period of time or at the end of the case. A waiver means that if you permanently lack the ability to pay the
fees/costs, you may have them waived and you will not have to pay them at all. The forms and instructions
for requesting a deferral or waiver are located in the packet entitled “Deferral/Waiver of Fees/Costs.”

Step 2 Filing your Petition – The forms and instructions for doing this are located in this packet.

Step 3 Service of Process – This means giving legal notice of what you have filed to your spouse. There are
several ways of doing this and the forms and instructions for this are located in the packet entitled “Service
of Papers on the Other Party.”

Step 4 Default Procedures – If your spouse contests what you are asking for in the Petition, he/she does so by
filing a written Response with the court. If your spouse does not file a Response or if he or she does file a
Response and both spouses later reach an agreement, the divorce can proceed as a Default. The forms
and instructions on how to proceed by Default are located in the packet entitled “Obtaining a Default.” If
your spouse has filed a Response and you and your spouse cannot reach an agreement, the Divorce will
proceed forward and a trial will be necessary. You should seek the advice of an lawyer under such
circumstances.

Step 5 Final Decree – Whether your spouse files a Response or you obtain a Default, at some point you will have
to prepare a final Decree for the judge or commissioner to sign. The Decree is the final order from the court
granting you the divorce and deciding the other issues related to the divorce. See packet entitled “Divorce
with Children Decree.”

DO NOT ATTEMPT TO FILL OUT ALL THE PAPERS IN ALL THE PACKETS AT THE BEGINNING OF THE
CASE. COMPLETE ONLY THOSE PAPERS THAT ARE NECESSARY FOR THE STEP THAT YOU ARE
WORKING ON. TRYING TO COMPLETE ALL THE PAPERS AT ONCE ONLY CAUSES CONFUSION.

IMPORTANT TERMS TO USE:

Because YOU are filing the Petition, YOU will be called the PETITIONER on all documents relating to your case,
regardless of who files any later documents. YOUR SPOUSE will be called the RESPONDENT on all documents.

BASIC REQUIREMENTS:

To file for divorce in Arizona, it is required that you OR your spouse must have resided in Arizona OR been stationed
in Arizona while a member of the Armed Forces for at least 90 days before the Petition is filed. The children
generally must have resided in Arizona for at least six months immediately before you file the Petition.

PARENT INFORMATION PROGRAM:

In every divorce case where there are minor children involved, parents must attend a “Domestic Relations Education
Regarding Children’s Issues” class. The purpose of this class is to give parents information about the impact that
divorce or changes in custody or visitation have on children.

There is a fee for this course (currently $27), but this fee may be deferred or waived along with other court fees if you
qualify. See the packet entitled “Deferral/Waiver of Fees/Costs” for the forms and instructions to do this.

Attendance at this class is mandatory for both parents, but you are not required to attend together. You are not
responsible for your spouse’s attendance. If a parent fails to attend and complete this class the court will not hear or
grant any request for custody or parenting time by this parent until the class is completed. The Clerk of the Court will
give you more information about this class when you file your papers.

MEDIATION: During your case you and your spouse may disagree on issues involving child custody or parenting
time (visitation). If so, you and your spouse must attend mediation either using the services of a court-appointed
mediator or a private mediator selected by you and your spouse prior to proceeding to trial. Use the forms and
instructions in the packet entitled “Mediation/Conciliation.”

1 dwcpetition-iintroduction.info
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INSTRUCTIONS FOR HOW TO FILL OUT FORMS

DIVORCE PETITION – WITH CHILDREN

PLEASE TYPE OR PRINT WITH BLACK INK ONLY
WHEN FILLING OUT ANY COURT FORMS

IMPORTANT NOTICE TO VICTIMS OF DOMESTIC VIOLENCE:

Unfortunately, domestic violence can be part of any marriage. Domestic violence can include physical violence
directed against you or your children such as hitting, slapping, pushing, or kicking. It can also include threats of
physical violence made against you and your children, or regular verbal abuse used to control you. Your spouse
does NOT need to have been convicted of domestic violence or assault for you to be a domestic violence victim, and
you do not need to have sought medical care or been admitted to a hospital to be a victim.

If you are a victim of domestic violence or threats of domestic violence, you can obtain an Order of Protection from
any court. This Order of Protection will order your spouse to stay away from you and from your children if they are
also victims of your spouse’s abuse. If you need an immediate order of protection and will not file at least for 30
days before you are ready to file for the divorce, you can request such an Order between the hours of 8:00 a.m. and
4:30 p.m. at the Tucson City Court, 103 East Alameda Street, Tucson, telephone number 791-4971; the Pima County
Consolidated Justice Court, 115 North Church Avenue, 2d floor, Tucson, telephone number 740-3171; the Pima
County Juvenile Court Center, 2225 East Ajo Way, Tucson, telephone number 740-2045; the Pima County Superior
Court Clerk’s Office, 110 West Congress, 1st floor, Tucson, telephone number 740-3210. After 4:30 p.m. weekdays,

or at any time on a weekend or holiday, an emergency order of protection can be requested by contacting the
Tucson Police Department at 741-4444 or the Pima County Sheriff’s Department at 740-4900. In case of an
emergency call 911.

If you are ready to file your divorce or plan on doing so within 30 days and also need an Order of Protection, you
should request the Order of Protection from the Superior Court where you file the divorce papers. The Clerk of the
Court will have the papers you need to do this. If you have an existing Order of Protection from City Court, it will
have to be transferred to Superior Court when you file your divorce papers.

ALL COURT DOCUMENTS WILL REQUEST YOUR ADDRESS AND PHONE NUMBER. IF YOU ARE A VICTIM
OF DOMESTIC VIOLENCE, ARE IN A DOMESTIC VIOLENCE SHELTER, OR YOU DO NOT WANT YOUR
ADDRESS KNOWN IN ORDER TO PROTECT YOURSELF OR YOUR CHILDREN, IF POSSIBLE, GET A P.O. BOX
OR USE ANOTHER VALID MAILING ADDRESS ON THESE PAPERS. TELL THE CLERK OF ANY EXISTING
ORDER OF PROTECTION AND CASE NUMBER.

Additional information on how to obtain an Order of Protection is available at the Self-Help Center.

Completing the DOMESTIC RELATIONS COVER SHEET: (dwcpetition-domestic cover sheet.form)

Print the word “None” on the line for Petitioner’s Attorney and Attorney No.

Print your (Petitioner’s) name and address and your spouse’s (Respondent’s) name in the spaces provided.
In the block entitled “EMERGENCY ORDER SOUGHT,” check the appropriate block if you are seeking an
Order of Protection along with the Petition for Dissolution.

Where the form states “Nature of Action,” put an “X” in the box next to “Dissolution”.

Leave the rest of the form blank.

Completing the SUMMONS: (dwcpetition-summons.form)

Fill in the following information where requested: Your name, street address, city, state, ZIP, telephone number;
name of Petitioner (your name); and name of Respondent (your spouse’s name) in two places.

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Completing the PRELIMINARY INJUNCTION: (dwcpetition-preliminary injunction.form)

Enter the names of the Petitioner (you) and the Respondent (your spouse).

NOTICE TO CREDITORS: (dwcpetition-notice re health insurance.info)

This notice provides important information about the effect of your divorce on your creditors. Please read carefully
and serve the respondent with a copy. A.R.S. §25-318(F).

Completing the PETITION FOR DISSOLUTION OF MARRIAGE (DIVORCE) WITH CHILDREN: (dwcpetition-
dissolution of marriage.form)

(Use this form ONLY if you are getting a divorce and there are children involved!)

Make sure your form is titled PETITION FOR DISSOLUTION OF MARRIAGE (DIVORCE) WITH CHILDREN.

In the top left corner of the first page, fill out the following: YOUR name; address; city, state and ZIP code;
and telephone number. See note above regarding Domestic Violence.

Fill in YOUR name in the space that says “Petitioner.” Remember, you will be the PETITIONER through the
whole case. In the space that says “Respondent,” fill in the name of your spouse, who will be the
RESPONDENT for the rest of your case.

STATEMENTS MADE TO THE COURT UNDER OATH

1. About Petitioner – Fill in your name, address, date of birth, occupation, and how long you have lived in
Arizona. This is basic information about YOU, the PETITIONER.

2. About Respondent – Fill in your spouse’s name, address, date of birth, occupation, and how long your
spouse has lived in Arizona. This is basic information about YOUR SPOUSE, the RESPONDENT.

3. About Our Marriage – This is general information about your marriage. Fill in the date you were married,
and the city and state where you were married. If you were married outside the United States, list the
country where you were married.

4. 90 Day Requirement – This tells the court that you OR your spouse has lived in Arizona, or been stationed
here while in the Armed Forces, for at least 90 days. Before you file a Divorce, this MUST be true. IF IT IS
NOT TRUE, YOU CANNOT FILE.

PROPERTY AND DEBTS:

THE INFORMATION YOU GIVE IN 5, 6, 7, AND 8 TELLS THE COURT ABOUT YOUR PROPERTY AND DEBTS
AND HOW YOU THINK PROPERTY AND DEBTS SHOULD BE DIVIDED.

Community property is generally any property you and your spouse acquired or earned during your marriage or
that was paid for during the marriage, regardless of who uses the property or who actually paid the money. Unless
property was a gift or inheritance, all property gotten during the marriage is community property, and both you and
your spouse are entitled to a roughly equal share of this property.

Community debts, likewise, belong to both people, regardless of who spent the money. These should also be
divided roughly equally.

Separate property is property that either spouse owned before the marriage or property that a spouse received
during the marriage by either gift or inheritance. Separate property is not divided during the divorce. Each party gets
to keep his or her separate property.

Separate debts are debts that either spouse had before the marriage OR that were incurred AFTER the divorce
Petition was served.

If you have questions, or you have a lot of community assets and/or debts, you should consult a lawyer regarding
issues of community property and debts BEFORE filing your Petition and other papers.

2 dwcpetition-instructions.info
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Community Property – If you and your spouse do not have any property from the marriage, mark the first box and
GO TO # 7. If you had property together check the second box. If you checked the second box, you will then tell the
court what property should go to you and what property should go to your spouse in # 6. Generally, the court will try
to divide the property roughly equally, unless there are good reasons not to. It is unlikely that the court will give most
or all of the property to either spouse, so try to put some thought into what you think would be a fair split before
answering this question.

List specific items of property and its approximate value and check which party should get the item of property.

You should describe the property as thoroughly as you need to for identification purposes. You can use the brand
name and model where applicable. You should identify all bank accounts, credit card accounts and insurance
policies by listing the last four digits of the account numbers.

Frequently the parties have already divided the property before filing for a divorce. If you and your spouse have
done this and there are no large items of property such as a vehicle or a home, you can check “Property in each
party’s possession” for each party. To be on the safe side, however, list specific property and who it is to be awarded
to.

Types of property include:

Real Estate (property or home) – mark who you want to get the property. You can ask the court to give the home
to you or to your spouse, or order it to be sold and proceeds divided between the parties. You should write the
complete address of the property under “Real estate at”. Most property also has a legal description such as “LOT
77, PINE TREE ACRES, according to Book 111 of Maps, etc.” You should use this description, which will appear on
your deed papers, if you have it. Cemetery plots are also considered real property. Mobile homes are real property
IF you own the land where the mobile home is sitting and the mobile home is permanently affixed to that land.
Otherwise, a mobile home is considered a vehicle.

Household furniture and appliances – this includes sofas, beds, tables, refrigerators, etc.

Household furnishings – this generally includes other things in the house other than furniture such as dishes, small
appliances, rugs etc.

Other (explain) – list any things that you specifically want to go to one person or another that have not already been
listed.

Pension/retirement fund/IRA/profit sharing/stock plan/401K – you and your spouse each generally have a right to
a one-half interest in any spouse’s plan, but ONLY for the number of years you were married and the pension or
retirement plan was in effect. The longer you have been married, the greater your financial interest in a spouse’s
plan, up to 50 percent if you have been together the whole period of the plan. Mark this box if you want the court
to divide either your or your spouse’s retirement or profit sharing/retirement/401K plan. If you mark this box,
you should see an attorney about a document called a Qualified Domestic Relations Order or QDRO. A
QDRO is very specialized legal document that requires a professional’s assistance to prepare.

If you are not sure whether you or your spouse has a retirement plan, consult a lawyer.

Motor vehicles – list the vehicle identification number, the year and make of car (Ford, Chevrolet) and the model
(Mustang, Camaro) etc. Also list any lien holders who are listed on the title to the vehicle. A lien holder is usually the
finance company who loaned you the money to purchase the vehicle.

Remember, mobile homes NOT permanently affixed to land that you own are considered vehicles.

Separate Property – If neither you nor your spouse still has any property that you had before the marriage, check the
first block AND GO TO # 7. If you do have such property or if you or your spouse received any gifts or inheritances
while you were married, check the second block and then describe each item of separate property and check which
party is to get each item.

Community Debts – If neither you nor your spouse owe money or have any debts from the marriage, mark the first
box and GO TO # 9. If you did acquire some debts, mark the second box. If you mark the second box, tell the court
what the debts are and who should be made to pay them. Generally, the court will attempt to make a fair split of the
debts, and if you get the property that money is owed on, you probably will also be given the debt. It is unusual for
the court to order one person to pay all the debts. Think about what is a fair split of the debts before answering this
question. Enter enough information to identify the specific debt.

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Keep in mind that while the divorce decree will order the debts to be split, this order is NOT binding on the creditors.
For example, if a community debt for a specific credit card was awarded to your spouse and that spouse did not pay
the debt, the creditor could still come after you on that debt. Your remedy would then be to take your spouse back
into the divorce court to enforce the decree.

Separate Debts – If neither you nor your spouse have individual debts from before you were married (or any debts
incurred while you have been separated), check the first block and GO TO # 10. If you do have separate debts,
check the second box and list the debts. Check which party should be ordered to pay each debt.

Tax returns – Mark the first box if this is how you want to handle income tax refunds. If you want some other
arrangement, check the “Other” box and describe the tax arrangement you want the court to award.

Spousal Maintenance (Alimony) – This is the term used to describe money paid by one spouse to the other as part
of a Divorce Decree or Order. You may know the term as alimony. The money is designed as a safety net for a
spouse who cannot provide for his or her needs or who meets other requirements listed under # 11. The idea behind
spousal maintenance is that accomplishments during your marriage, including increases in earning potential and
living standards are shared and earned by BOTH parties to a marriage. Look at the list of boxes in # 11 and see if
any of these apply to you or your spouse. If so, you can decide to make a request that spousal maintenance be
awarded to the appropriate party. If none apply, or you do not want to request spousal maintenance, check the first
block and GO TO # 12. If you want either party to receive spousal maintenance, check the second block and all
other blocks that apply to the receiving spouse.

Spousal maintenance is paid separate from child support and is NOT a substitute for or supplement to child
support.

INFORMATION ABOUT CHILDREN LESS THAN 18 YEARS OF AGE

Domestic Violence – This tells the court if there was ANY domestic violence in the marriage, and relates to a
request for joint custody, if you intend to ask for joint custody. If you are not sure what this means, see the
IMPORTANT NOTICE TO VICTIMS OF DOMESTIC VIOLENCE on the first page of these instructions. Mark the
first box if there has been domestic violence. If domestic violence has not occurred, GO TO # 13.

Children Who Are Less Than 18 Years Old – If there are no children under the age of 18 that have been born to
or adopted by you or your spouse, you should STOP! You should be using the packet entitled “Petition for
Dissolution of Marriage (Divorce) Without Children”. Otherwise, check the second box and provide the name,
birth date and current home address for each child born to or adopted by you and your spouse.

Pregnancy – If the wife is not pregnant, check the first box in # 14 and GO TO # 15. If the wife IS pregnant, check
the second block and list the date the baby is due. Also check the appropriate block that describes who are the
parents of that child.

Children Under 18 Who Are Not Children of One of the Spouses – Write the name, birth date and home address
of any child less than 18 years of age who was born during the marriage BUT for whom either YOU or YOUR
SPOUSE are NOT the parent. If this is not applicable, leave this section blank and GO TO # 16.

Written Custody Agreement – Check the box in # 16 ONLY if you and your spouse already have a signed, written
agreement regarding custody, parenting time and child support BEFORE you file. If you have only discussed these
issues and do not have a signed, written agreement, do NOT mark this box.

Jurisdiction of the Court to Award Child Support – The court must have jurisdiction over the other party in order to
award child support against that party. If that party is a resident of Arizona, this does not present a problem.
However, if the other party is NOT an Arizona resident, the court cannot award child support against that party unless
he or she has had some specific connection with Arizona. Be sure to check every box in # 17 that applies to that
party.

OTHER STATEMENTS MADE TO THE COURT UNDER OATH

Each of these statements must be true at the time you file for the divorce. If any of these statements is NOT true,
you cannot file for a divorce until all the statements are true.

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REQUESTS I MAKE TO THE COURT – In this portion of the Petition, numbered 1 to 12, you are telling the
court what you want ordered in the final decree.

Dissolution – This is your request to end your marriage by a Dissolution of Marriage (Divorce).

Names – Mark the appropriate box if you are requesting that you or your spouse to legally be known by your maiden
or former name. Write in the appropriate last name on the space provided.

Spousal Maintenance (Alimony) – If neither party is requesting spousal maintenance, mark the first box and GO TO
# 4. If you are asking the court to order one spouse to pay spousal maintenance to the other spouse, check the
appropriate boxes and enter the amount of spousal maintenance requested.

Community Property – This tells the court that your requested division of the community property is fair, and that the
court should divide the community property as requested above in your Petition.

Community Debts – This tells the court that your requested division of the community debts is fair, and that the court
should divide the community debts as requested above in your Petition. IF YOU HAVE BEEN SEPARATED FROM
YOUR SPOUSE FOR ENOUGH TIME THAT YOU OR YOUR SPOUSE MAY HAVE ADDITIONAL DEBTS, WRITE
THE DATE OF SEPARATION ON THE LINE PROVIDED IF YOU WANT EACH OF YOU TO PAY THE DEBTS YOU
CAUSED AFTER YOU SEPARATED.

Separate Property – This states you want you and your spouse to keep property you each owned before you were
married or got during the marriage by gift or inheritance as requested above in your Petition.

Separate Debts – This states that you want you and your spouse to be responsible for debts that each of you had
from before the marriage as requested above in the Petition.

Child Custody and Parenting Time (Visitation)

Sole Custody – If you are requesting one party to have sole custody of the minor children, check this box and then
check the appropriate blocks regarding parenting time by the other parent.

Parenting Time:

Reasonable Parenting Time – Mark this box if you want the person not having sole custody to have reasonable
parenting time rights. Reasonable parenting time varies with the age of the child. The court offers suggested
amounts of parenting time and these are in published guidelines available in the packet entitled “Child
Custody/Parenting Time/Support” and in “The Model Parenting Time Plans” available at the Self-Help Center.
The parents can agree on other parenting time arrangements, however.

Supervised Parenting Time – Mark this box if you want the other party’s parenting time to be supervised by another
adult. You may request supervised parenting time if the non-custodial parent cannot adequately care for the children
or cannot do so without another person present. You may request this if the person not having custody abuses
drugs or alcohol; is violent or abusive; or does not have the parenting skills to care for a child without another adult
present. Remember, supervised parenting time is not intended to punish the parent, but to protect the child. Be sure
to list the reasons why you are requesting supervised parenting time. Also list who is going to pay the costs of
supervised parenting time, if any are incurred.

No Parenting Time – Mark this box if you want the other party to have no parenting time at all. You should check
this block only if the non-custodial parent has seriously harmed, abused, or otherwise is a serious danger to the
child’s physical and/or emotional health. This is a last resort to protect the child.

Joint Custody – If you are requesting joint custody, mark this box. You and your spouse should complete a Joint
Custody Agreement or Parenting Plan and attach a copy to your Petition.

Child Support – Indicate which parent is to pay child support. The person who has custody of the child(ren), or who
has physical care of the child(ren) more than 50% of the time, is the person who should receive the support. The
other spouse must pay the support. The amount of the support is generally determined by income of the parties
according to the Arizona Child Support Guidelines. The amount of child support does not have to be specifically
stated at this time, but it will need to be computed later so that it can be specifically listed in the Decree.

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Insurance and Health Care Expenses for Children – Mark one box only. Tell the court which parent should be
required to provide insurance for the children. Whichever parent has the most affordable plan available through their
employment, where applicable, should generally pay the insurance. Adjustments can be made to Child Support to
reflect costs of insurance for the children.

Tax exemption – The Arizona Child Support Guidelines and federal tax laws determine who should get the tax
dependency exemptions, for which children, for which years. If you are not sure you should see a lawyer or
accountant for help.

Other Orders – Tell the court anything else you may want ordered in your Divorce that has not been covered
elsewhere in your Petition. If none, enter “None.”

OATH AND VERIFICATION OF PETITIONER: Sign this form in front of a notary. By doing so you are telling the
court that everything contained in the Petition for Dissolution is true. Generally, you should sign all papers that you
are filing at the Superior Court Clerk’s Office. The Clerk will notarize the papers.

You will also have to complete the following forms; Affidavit Re: Minor Children, and Sensitive Information Sheet

NOTICE OF RIGHT TO CONVERT HEALTH INSURANCE: (dwcpetition-notice re health insurance.info)

This is an important document that explains what to do about health care coverage for yourself and your children.
Read it carefully, and be sure a copy is served with the other divorce papers on your spouse.

AFFIDAVIT RE: MINOR CHILDREN: (dwcpetition-affidavit re minor children.form)

Enter the names of Petitioner and Respondent.

Check “Dissolution.”

Check whether the wife is presently pregnant.

Check whether there are minor children of either or both parties who are in the custody of either or both of
the parties.

Check whether there were prior cases involving custody or parenting time of your minor children in this or
any other state. If there were other cases, mark the first box and give as much information as possible.
This information could affect you or your children’s rights in this case.

Check whether there are any PENDING cases involving custody of your minor children in this or any other
state. If there are other cases, mark the first box and give as much information as possible. This information
could affect you or your children’s rights in this case.

Check whether you know of another person OTHER THAN YOUR SPOUSE who has physical custody or is
claiming custody or parenting time rights to any of the children. If you do know such person, mark the first
box and put the information here, including the child’s name and the person who believes they have a
custody or parenting time claim.

List the wife’s mailing address.

List the husband’s mailing address.

Enter each child’s name, birth date, and birthplace.

Enter where the children from your marriage have been living for the past 5 years; if any children are under
age 5, simply put information since their birth. Write the dates of residence, the address where the child
lived during the period, the name and present address of the person having physical custody of the child
during the period, and the relationship of that person to the child. While you may not remember exact dates
when you moved from one location to another, fill this information out as completely as possible.

Sign this document before the Clerk of the Court or a Notary Public and check the box labeled “Petitioner.”

6 dwcpetition-instructions.info
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———————– Page 11———————–

SENSITIVE INFORMATION SHEET: (dwcpetition-sensitive information.form)

Because the divorce Petition is a public document, certain information such as your social security number and those
of your spouse and children as well as information regarding asset and debt account numbers are furnished to the
court on this sheet, which is not made available to the public.

Print the word “None” requested in the line for Petitioner’s Attorney and Attorney No.

Provide all other information pertaining to you, your spouse and your children, to the best of your ability.

Now that you have completed the forms, refer to the final sheet in this packet entitled “General Information
on Filing Papers”. This will tell you what to do with the forms you have completed.

7 dwcpetition-instructions.info
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DOMESTIC RELATIONS COVER SHEET For Court Use Only

Complete this form to the best of your ability and

include all known petitioners and respondents. DATE FILED: ________________________

CASE NUMBER: ______________________

JUDGE: _____________________________

PLEASE TYPE OR PRINT

PETITIONER’S ATTORNEY ____________________________________________ ATTORNEY No. __________

PETITIONER’S NAME (s) (List All) PETITIONER’S ADDRESSES (s)
(Include only if not represented by an attorney)
______________________________________ ________________________________________________

______________________________________ ________________________________________________

______________________________________ ________________________________________________

RESPONDENT’S NAME (s) (List All) CASE PREFERENCE _____________________________
(cite statute or rule)
______________________________________
EMERGENCY ORDER SOUGHT:
______________________________________ TEMPORARY Restraining Order
PRELIMINARY INJUNCTION
OTHER ______________________________________
(Specify)

NATURE OF ACTION

Place an “x” in the box which describes the nature of the case you are filing.
If more than one, circle the predominant one.

DISSOLUTIONS (300) UNCLASSIFIED DOMESTIC (370)

Dissolution Domestic Custody
Foreign Decree
Pre-Judgment OSC
Post-Judgment OSC
Special Paternity – Maternity (310)
Annulment (320)
Legal Separation (330)
Reciprocal Support (350)
Domestic Violence (360)

1 dwcpetition-domestic cover sheet.form
Revised 07.23.09

———————– Page 13———————–

Name: ___________________________________

Address: _________________________________

City, State, ZIP: ____________________________

Daytime Telephone No: ______________________

Representing Self, Without a Lawyer

ARIZONA SUPERIOR COURT, PIMA COUNTY

______________________________________ Case No. _________________
Petitioner/Plaintiff
and
SUMMONS
______________________________________ (Family Law)
Respondent/Defendant

WARNING. THIS IS AN OFFICIAL DOCUMENT FROM THE COURT THAT AFFECTS YOUR RIGHTS. READ
THIS SUMMONS CAREFULLY. IF YOU DO NOT UNDERSTAND IT, CONTACT AN ATTORNEY FOR LEGAL
ADVICE.

FROM THE STATE OF ARIZONA TO _____________________________________.
(Name of Respondent)
1. A lawsuit has been filed against you. A copy of the lawsuit and other related court paperwork is served on
you with this Summons.

2. If you do not want a judgment taken against you without your input, you must file a Response in writing with
the Court, and you must pay the required filing fee. To file your Response, take or send the papers to:
Office of the Clerk of the Superior Court, 110 West Congress, Tucson, Arizona 85701. Mail a copy of
the Response to your spouse, the Petitioner, at the address listed on the top of this Summons.

3. If this Summons and the other court papers were served on you within the State of Arizona, your Response
must be filed within TWENTY (20) CALENDAR DAYS from the date of the service, not counting the day of
service. If the papers were served on you outside the State of Arizona, your Response must be filed within
THIRTY (30) CALENDAR DAYS, not counting the day of service.

4. Requests for reasonable accommodations for persons with disabilities must be made to the court by parties
at least 3 working days in advance of a scheduled court proceeding.

5. Either spouse, or both spouses, may file in the conciliation court a petition invoking the jurisdiction of the
court for the purpose of preserving the marriage by effecting conciliation between the parties.

GIVEN under my hand and the Seal of the Superior Court of the State of Arizona in and for the County of
Pima this _____ day of _______________, 20_____.

CLERK OF THE SUPERIOR COURT

By____________________________
Deputy Clerk

1 dwcpetition-summons.form
Revised 07.23.09

———————– Page 14———————–

Name: ___________________________________

Address: _________________________________

City, State, ZIP: ____________________________

Daytime Telephone No: ______________________

Representing Self, Without a Lawyer

ARIZONA SUPERIOR COURT, PIMA COUNTY

______________________________________ Case No. _________________
Petitioner/Plaintiff
and
PRELIMINARY INJUNCTION
______________________________________ FROM THE COURT AGAINST
Respondent/Defendant BOTH PETITIONER AND
RESPONDENT

WARNING TO PETITIONER AND RESPONDENT: THIS IS AN OFFICIAL ORDER FROM THE COURT. IT
AFFECTS YOUR RIGHTS. READ THIS ORDER IMMEDIATELY AND CAREFULLY. IF YOU DO NOT
UNDERSTAND IT, CONTACT AN ATTORNEY FOR LEGAL ADVICE.

A Petition for Dissolution (Divorce) has been filed with the court by your spouse. As a result, this Order is made at
the direction of the Presiding Judge of the Superior Court of Arizona, Pima County, under the authority of Arizona
Law, A.R.S. § 25-315 (A). This Order has the same force and effect as an Order personally signed by the Judge.
You and your spouse are required to follow this Order. It may be enforced by any remedy available under the law,
including an order of CONTEMPT OF COURT.

1. ACTIONS BY YOU OR YOUR SPOUSE WHICH ARE FORBIDDEN BY THIS ORDER: From the time this
Petition for Dissolution (Divorce) is filed with the court, until a Decree of Divorce is entered, or until further
Order of the court, both the PETITIONER AND THE RESPONDENT shall not, by Order of this court, take
any of the following forbidden actions:

NOTE: THE LAW REQUIRES THAT THE EXACT LANGUAGE OF A.R.S. § 25-315(A) BE INCLUDED IN
THIS ORDER. FURTHER EXPLANATION OF THE REQUIREMENTS OF THIS ORDER ARE INCLUDED
HERE BEFORE THE ACTUAL STATUTE (LAW). READ THE EXPLANATION, WHICH IS FOLLOWED BY
THE STATUTE ITSELF. IF YOU HAVE FURTHER QUESTIONS YOU SHOULD CONTACT AN
ATTORNEY FOR LEGAL ADVICE.

a. RESTRICTIONS ON YOUR JOINT PROPERTY: This Order recognizes that since you and your spouse
both may have an interest in property acquired or paid for during the marriage, you may not hide
earnings or property from your spouse; you may not take out a loan on any of this property; you may not
sell it or give it away to someone else, UNLESS you have the written permission of your spouse or
permission in writing from the court. The law does recognize that there may be situations where joint or
community property may need to be transferred as part of the everyday running of a business, or that
occasionally the sale of community property is necessary to meet necessities of life, such as food,
shelter, or clothing or court fees and reasonable attorney fees associated with this action.

1 dwcpetition-preliminary injuction.form
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———————– Page 15———————–

b. RESTRICTIONS ON YOUR BEHAVIOR: The Order is designed to protect you, your spouse, and
your children from actions by your spouse which may be disruptive, or physically or emotionally
harmful. While Divorce can be a difficult process, it does not give either spouse the right to either
harass or bother the other spouse or the children. The court does not tolerate physical abuse or
threats in any form.

c. RESTRICTIONS ABOUT YOUR CHILDREN: This Order specifically states that you cannot take
your common children out of the state of Arizona for any reason, without a written agreement
between you and your spouse or a court Order, before the children are taken from the state. This
Order is designed to allow both parents continuing access to and contact with the children.

d. RESTRICTIONS ABOUT INSURANCE: Do not remove or cause to be removed the other party or
the children of the parties from any existing insurance coverage, including medical, hospital, dental,
automobile and disability insurance. Both parties shall maintain all insurance coverage in full force
and effect.

Arizona Law, A.R.S. § 25-315(A) specifically provides as follows:

1. The preliminary injunction shall be directed to each party of the action and contain the following orders:

a. That both parties are enjoined from transferring, encumbering, concealing, selling or otherwise
disposing of any of the joint, common or community property of the parties except if related to the
usual course of business, the necessities of life, or court fees and reasonable attorney fees
associated with an action filed under this article, without the written consent of the parties or the
permission of the court.

b. That both parties are enjoined from molesting, harassing, disturbing the peace of or committing an
assault or battery on the person of the other party or any natural or adopted child of the parties.

c. That both parties are enjoined from removing any natural or adopted child of the parties then residing
in Arizona from the jurisdiction of the court without the prior written consent of the parties or the
permission of the court.

d. That both parties are enjoined from removing or causing to be removed the other party or the
children of the parties from any existing insurance coverage, including medical, hospital, dental,
automobile and disability insurance. That both parties shall maintain all insurance coverage in full
force and effect.

2. EFFECTIVE DATE OF THIS ORDER: This Order is effective against the person who filed for divorce (the
Petitioner) when the Petition was filed with the court. It is effective against the other party (the Respondent)
when it is served according to law. If service is made upon the Respondent by registered mail according to
the Arizona Rules of Civil Procedure, the Order is effective upon receipt of the Order by the Respondent.
This Order shall remain in effect until further order of the court, or the entry of a Decree of Dissolution, Legal
Separation, or Annulment is filed or the action is dismissed.

3. ADDITIONAL ORDER TO PETITIONER: You must serve a copy of this Order upon the Respondent with
the copy of the Petition for Dissolution or Legal Separation and the Summons and other required court
papers.

WARNING

THIS IS AN OFFICIAL COURT ORDER. IF YOU DISOBEY THIS ORDER, THE COURT MAY FIND YOU IN
CONTEMPT OF COURT. YOU MAY ALSO BE ARRESTED AND PROSECUTED FOR THE CRIME OF
INTERFERING WITH JUDICIAL PROCEEDINGS AND ANY OTHER CRIME YOU MAY HAVE COMMITTED IN
DISOBEYING THIS ORDER.

YOU OR YOUR SPOUSE MAY FILE A CERTIFIED COPY OF THIS ORDER WITH YOUR LOCAL LAW
ENFORCEMENT AGENCY. A CERTIFIED COPY MAY BE OBTAINED FROM THE CLERK OF THE COURT
WHICH ISSUED THIS ORDER. IF YOU ARE THE PERSON THAT BROUGHT THIS ACTION, YOU MUST ALSO

2 dwcpetition-preliminary injuction.form
Revised 07.23.09

———————– Page 16———————–

FILE EVIDENCE WITH THE LAW ENFORCEMENT AGENCY THAT THIS ORDER WAS SERVED ON YOUR
SPOUSE.

THIS COURT ORDER IS EFFECTIVE UNTIL A FINAL DECREE OF DISSOLUTION OR OF LEGAL SEPARATION
IS FILED OR THE ACTION IS DISMISSED.

GIVEN UNDER MY HAND AND THE SEAL OF THE COURT this ____ day of _______________ 20 _____.

Clerk of the Superior Court

By: _______________________________________
Deputy Clerk

3 dwcpetition-preliminary injuction.form
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———————– Page 17———————–

Name: ___________________________________

Address: _________________________________

City, State, ZIP: ____________________________

Daytime Telephone No: ______________________

Representing Self, Without a Lawyer

ARIZONA SUPERIOR COURT, PIMA COUNTY

______________________________________ Case No. _________________
Petitioner/Plaintiff
and
PETITION FOR DISSOLUTION
______________________________________ OF MARRIAGE (DIVORCE)
Respondent/Defendant WITH CHILDREN

STATEMENTS MADE TO THE COURT, UNDER OATH

1. ABOUT ME, THE PETITIONER
Name: ________________________________________________
Address: _______________________________________________
Date of Birth: __________________________
Occupation: ___________________________
Length of time I have lived in this state: _______________________

2. ABOUT, MY SPOUSE, THE RESPONDENT
Name: ________________________________________________
Address: _______________________________________________
Date of Birth: __________________________
Occupation: ___________________________
Length of time my spouse has lived in this state: _______________________

3. ABOUT OUR MARRIAGE
Date of Marriage: ________________________
City and state or country where we were married: _____________________________

4. 90-DAY REQUIREMENT
Either I and/or my spouse, has lived or been stationed, while a member of the Armed Forces, in Arizona
for at least 90 days before I filed this petition. (WARNING TO PETITIONER: IF THIS STATEMENT IS NOT
TRUE, YOU CANNOT FILE FOR DISSOLUTION UNTIL IT BECOMES TRUE).

1 dwcpetition-petition – dissolution of marriage.form
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———————– Page 18———————–

5. COMMUNITY PROPERTY (PROPERTY ACQUIRED DURING THE MARRIAGE) – check one box
My spouse and I did not acquire any community property during the marriage.
My spouse and I did acquire community property during our marriage, and it should be divided as
follows:

6. DESCRIPTION AND VALUE OF THE PROPERTY PETITIONER RESPONDENT
Property in each party’s possession

Real estate at:
Legal Description: _____________________________
_____________________________________________

Real estate at:
Legal Description: _____________________________
_____________________________________________

Household furniture and appliances:

Household furnishings:

Other items

Pension/Retirement Fund/Profit Sharing/Stock Plan/401K:

Motor vehicles:
Make: Model:
VIN: Lien Holder:
Make: Model:
VIN: Lien Holder: _______________

2 dwcpetition-petition – dissolution of marriage.form
Revised 07.23.09

———————– Page 19———————–

7. SEPARATE PROPERTY (PROPERTY ACQUIRED BEFORE THE MARRIAGE) – check one box
My spouse and I do not have any property either of us brought into the marriage.
My spouse and I do have property that either of us brought into the marriage and it should be
awarded as follows:

Description and Value of Property PETITIONER RESPONDENT
___________________________________________________

8. COMMUNITY DEBTS (DEBTS INCURRED DURING THE MARRIAGE) – check one box
My spouse and I did not incur any community debts during the marriage.
My spouse and I did incur community debts during the marriage and responsibility for these debts
should be divided as follows:

Description and Amount of Debt PETITIONER RESPONDENT

9. SEPARATE DEBTS (DEBTS INCURRED BEFORE THE MARRIAGE) – check one box
My spouse and I do not have any debts that were incurred before the marriage.
My spouse and I do have separate debts that were incurred before the marriage and the
responsibility for these debts should be divided as follows:

Description and Amount of Debt PETITIONER RESPONDENT

10. TAX RETURNS – check one box
After the Judge or Commissioner signs the Decree of Dissolution of Marriage (Divorce), my spouse
and I will pay federal and state taxes as follows: For previous years (the years we were married but not
including the year the Decree was signed), my spouse and I will file joint federal and state income tax
returns. In addition, for these previous years, my spouse and I will pay and hold the other harmless from ½
of all additional income taxes, if any, and all other costs, and we will share equally in any refunds. For the
calendar year that the decree was signed, my spouse and I will file separate federal and state income tax
returns and each will give the other party all necessary documentation to do so.

Other – describe any other tax arrangements you wish the Court to award

3 dwcpetition-petition – dissolution of marriage.form
Revised 07.23.09

———————– Page 20———————–

11. SPOUSAL MAINTENANCE (ALIMONY) – check the box that applies to you
Neither party is entitled to spousal maintenance (alimony).
Petitioner OR Respondent is entitled to spousal maintenance because: (check ANY boxes that
apply. At least one must apply to get spousal maintenance)
Person lacks sufficient property to provide for his or her reasonable needs
Person is unable to support himself or herself through appropriate employment
Person is the custodian of a child or children whose age or condition is such that person
should not be required to seek employment outside the home
Person lacks earning ability in the labor market adequate to support himself or herself
Person contributed to the educational opportunities of the other spouse
Person had a marriage of long duration and is now of an age that precludes the possibility of
gaining employment adequate to support himself or herself

INFORMATION ABOUT OUR CHILDREN LESS THAN 18 YEARS OF AGE:

12. DOMESTIC VIOLENCE – check the box that is true if you or your spouse intends to ask for joint custody
Domestic violence has has not occurred during this marriage.

13. CHILDREN OF THE PARTIES WHO ARE LESS THAN 18 YEARS OLD – check one box
There are no children under the age of 18 either born to or adopted by the parties. NOTE: IF YOU
CHECKED THIS BOX, STOP! YOU SHOULD BE USING THE PACKET ENTITLED “PETITION
FOR DISSOLUTION OF MARRIAGE (DIVORCE) WITHOUT CHILDREN”
The following child(ren) are under age 18 and was/were born to or adopted by my spouse and I:
(Attach extra pages if necessary).

Name Name _______________________________
Birth date Birth date _____________________________
Address Address ______________________________

______________________________

Name Name _______________________________
Birth date Birth date _____________________________
Address Address ______________________________
______________________________
14. PREGNANCY
Wife is not pregnant OR
Wife is pregnant and the baby is due on and, (check one box below)
My spouse and I are the parents of the child, OR
I am not the parent of the child, OR
My spouse is not the parent of the child.

15. CHILDREN LESS THAN 18 YEARS OLD WHO WERE BORN DURING THE MARRIAGE FOR WHOM
EITHER ME OR MY SPOUSE IS NOT THE PARENT: (if applicable)

Name Name _______________________________
Birth date Birth date _____________________________
Address Address ______________________________
______________________________

4 dwcpetition-petition – dissolution of marriage.form
Revised 07.23.09

———————– Page 21———————–

16. WRITTEN CUSTODY AGREEMENT – check only if true

My spouse and I have a written agreement signed by both of us about the custody, visitation, and
child support for our child(ren). I have attached a copy of this agreement.

17. CHILD SUPPORT JURISDICTION -This Court has jurisdiction under A.R.S. § 25-623 to order the other
party to pay child support because:
That person is a resident of Arizona
I believe I will personally serve that person in Arizona
That person agrees to have the case heard here and will file written court papers in this case
That person resided with the child in this state
That person resided in this state and provided pre-birth expenses or support for the child
The child resides in this state as the result of the acts or directives of that person
That person had sexual intercourse in this state and the child may have been conceived by that act
of intercourse
That person signed a birth certificate that is filed in this state
That person did other acts which substantially connect that person with this state

18. OTHER STATEMENTS MADE TO THE COURT UNDER OATH – To obtain a divorce, you must be able to
tell the Court that each of the following statements is true. If any of the statements is not true you cannot file
for divorce until all the statements are true.
TRUE My marriage is irretrievably broken and there is no reasonable prospect of reconciliation.
TRUE My marriage is not a covenant marriage.
TRUE The conciliation requirements under Arizona law either do not apply or have been met.
TRUE This court has jurisdiction to decide child custody matters under Arizona law.

REQUESTS I MAKE TO THE COURT

1. DISSOLUTION (DIVORCE): Dissolve the marriage and return each party to the status of a single person.

2. NAMES: Restore wife husband to her or his former name of _________________________________.
Note: If you are not the person who is requesting to have your former name restored, the Court must have a
written request from the party who wants his or her name restored.

3. SPOUSAL MAINTENANCE (ALIMONY):
Neither party is entitled to spousal maintenance.
Order spousal maintenance to be paid by:
Petitioner Respondent to Petitioner Respondent
in the amount of _________ per month beginning on the first day of the month after the Judge or
Commissioner signs the Decree of Dissolution of Marriage or the first day of the month following the
service of the Petition for Dissolution of Marriage, and continuing until the person receiving the spousal
maintenance is remarried or deceased, or for _________ months, whichever occurs first. Payments to be
made directly to the person receiving the spousal maintenance, or payments, plus the statutory handling
fee, to be paid through The Support Payment Clearinghouse, PO Box 52107, Phoenix, Arizona 85072-
7107.

5 dwcpetition-petition – dissolution of marriage.form
Revised 07.23.09

———————– Page 22———————–

4. COMMUNITY PROPERTY: Make a fair division of all community property as requested above in this
Petition.

5. COMMUNITY DEBTS: Order each party to pay community debts as requested above in this Petition, and to
pay any other community debts unknown to the other party. Order each party to pay and hold the other party
harmless from debts incurred by him or her since the parties separated on (date:)

6. SEPARATE PROPERTY: Award each party his or her separate property as requested above in this
Petition.

7. SEPARATE DEBTS: Order each party to pay his or her separate debts as requested above in this Petition.

8. CHILD CUSTODY AND PARENTING TIME (VISITATION): Award custody and parenting time of the
children common to the parties and less than 18 years old as follows:

SOLE CUSTODY of the minor child(ren) awarded to: Petitioner OR Respondent, subject to
parenting time as follows:

Reasonable parenting time to the parent not having custody

OR

Supervised parenting time between the child(ren) and the Petitioner OR
Respondent is in the best interest of the child(ren) because __________________
___________________________________________________________________
__________________________________________________________ __
The cost of supervised parenting time will be paid by the parent being supervised;
the parent having custody; shared equally by the parties.

OR

No parenting time to the parent not having custody is in the best interest of the
child(ren) because ____________________________________________________
___________________________________________________________________

JOINT CUSTODY: Petitioner and Respondent agree to act as joint custodians of the child(ren)
as set forth in the Joint Custody Agreement or Parenting Plan signed by the
parties, and attached to this Petition.

9. CHILD SUPPORT: Order that child support shall be paid by:
Petitioner Respondent to Petitioner Respondent
in a reasonable amount as determined by the court under the Arizona Child Support Guidelines (Child
Support Order to be attached to Decree). Support payments to begin on the first day of the month after the
Judge or Commissioner signs the Decree of Dissolution of Marriage or on the first day of the month after
service of the Petition with all payments, plus the statutory handling fee, to be paid through The Support
Payment Clearinghouse, PO Box 52107, Phoenix, Arizona 85072-7107 to be paid by automatic wage
assignment.

6 dwcpetition-petition – dissolution of marriage.form
Revised 07.23.09

———————– Page 23———————–

10. INSURANCE AND HEALTH CARE EXPENSES FOR CHILDREN: Order that Petitioner
Respondent shall pay for health, medical, and dental insurance coverage for the child(ren) common to the
parties and less than the age of 18 years old. Petitioner and Respondent will pay for all reasonable
unreimbursed medical, dental, heath-related expenses incurred for the child(ren) in proportion to their
respective incomes as described on the Parents’ Worksheet, which shall be submitted with the Decree.

11. TAX EXEMPTION: The parties shall claim as income tax dependency exemptions on federal and state
income tax returns as follows:
Parent entitled to claim Name of child Current tax year Later tax years
Petitioner Respondent _________
Petitioner Respondent _________
Petitioner Respondent _________
Petitioner Respondent _ _________

12. OTHER ORDERS THAT I AM REQUESTING: (explain request here) ______________________________
_______________________________ _______________________________________________ __
______________________________________________________________________________________
______________________________________________________________________________________

OATH AND VERIFICATION OF PETITIONER:

STATE OF ARIZONA )
) ss.
County of Pima )

I, _____________________________, the Petitioner, being duly sworn and under oath, state that I have read this
Petition. All the statements in the Petition are true, correct and complete to the best of my knowledge and belief.

SIGNED: ___________________________________________
Petitioner

Subscribed and sworn to before me this day of , 20 ____ by
.
(Petitioner’s Name)

_____________________________________________
Notary Public

My Commission Expires:

_______________________________

7 dwcpetition-petition – dissolution of marriage.form
Revised 07.23.09

———————– Page 24———————–

NOTICE OF YOUR RIGHTS ABOUT HEALTH INSURANCE COVERAGE
WHEN A PETITION FOR DISSOLUTION (DIVORCE) IS FILED
(A.R.S. §§ 20-1377 and 20-1408)

WARNING: THIS IS AN IMPORTANT LEGAL NOTICE. YOUR RIGHTS TO HEALTH INSURANCE COVERAGE
COULD BE AFFECTED AFTER YOUR DIVORCE IS FINAL. READ THIS NOTICE CAREFULLY. IF YOU DO
NOT UNDERSTAND THIS NOTICE, YOU SHOULD CALL AN ATTORNEY FOR ADVICE ABOUT YOUR LEGAL
RIGHTS AND OBLIGATIONS.

IMPORTANT INFORMATION IF YOU ARE ON YOUR SPOUSE’S INSURANCE PLAN: When a Petition for
Dissolution of Marriage (papers for a divorce decree) is filed, you or your children may continue to be covered under
your spouse’s health insurance policy. Arizona law allows the dependent spouse and children to continue to be
covered, but you must take some steps to protect your rights.

WHAT INSURANCE COVERAGE APPLIES TO YOU, AND HOW TO GET IT: If you are covered by your spouse’s
health insurance, and you want to continue to be covered after the divorce is final, you must contact the insurance
company as soon as possible, and you must start to pay the monthly insurance premium within 31 days of the date
the insurance would otherwise stop.

If you decide you want to be covered, the insurer can choose whether to continue coverage under the current policy,
or to change the policy to your name. If the policy is changed to your name, it is called a “converted”; policy. If the
policy is converted by the insurer, the insurer must provide to you the same or the most similar level of coverage
available, unless you ask for a lower level of coverage.

WHAT COVERAGE APPLIES TO YOUR CHILDREN: If you choose to continue coverage as a dependent spouse,
you can also choose to continue coverage for your dependent children if you are responsible for their care or
support.

PREEXISTING CONDITIONS OR EXCLUSIONS FROM INSURANCE COVERAGE: Whether the insurance is
continued or converted, the insurance must be provided to you without proof of insurability and without exclusions for
coverage other than what was previously excluded before the insurance was continued or converted.

LIMITS ON RIGHTS TO INSURANCE COVERAGE FOR YOU AND YOUR CHILDREN: You may not be entitled to
continued or converted coverage if you are eligible for Medicare or for coverage by other similar types of insurance
which together with the continued coverage would make you over insured. However, dependent children of a person
who is eligible for Medicare may be covered by a continuance or a conversion. If you have questions about
coverage, check with the insurer and/or the spouse’s employer.

WARNING TO THE SPOUSE FILING THE PETITION FOR DISSOLUTION (DIVORCE): This Notice must be
served on your spouse together with the Petition for Dissolution, the Summons, and the Preliminary
Injunction.

Form approved by State of Arizona
Department of Insurance

1 dwcpetition-nottice re health ins.info
Revised 07.23.09

———————– Page 25———————–

Name: ___________________________________
Address: _________________________________

City, State, ZIP: ____________________________

Daytime Telephone No: ______________________

Representing Self, Without a Lawyer

ARIZONA SUPERIOR COURT, PIMA COUNTY

______________________________________ Case No. _________________
Petitioner/Plaintiff
and
AFFIDAVIT RE:
______________________________________ MINOR CHILDREN
Respondent/Defendant

STATE OF ARIZONA )
) ss.
County of Pima )

1. The nature of this action is:
Dissolution Legal Separation Paternity Annulment Child Custody Modification

2. The mother is is not presently pregnant.

3. There are are not minor children of either or both of the parties in this case who are in the custody of
either or both of the parties.

4. I have have not participated as a party, witness, or in any other capacity in any other prior litigation
concerning custody of a child mentioned below, in this or any other state. (If you have, state the name of
each child, the manner in which you participated, the court, the state & county or district, case number, and
date of order or judgment, if any.)

______________________________________________________________________________________
______________________________________________________________________________________
______________________________________________________________________________________
______________________________________________________________________________________

5. I do do not have any information of any custody proceeding concerning a child mentioned below
pending in a court of this or any other state. (If you do, state the name of each child, nature of the
proceeding, the court, the state & county or district, case number, and the status of the proceeding.)
______________________________________________________________________________________
______________________________________________________________________________________
______________________________________________________________________________________
______________________________________________________________________________________

1 dwcpetition-nottice re health ins.info
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———————– Page 26———————–

6. I do do not know of any person not a party to this proceeding who has physical custody or claims to
have custody or visitation rights with respect to any child mentioned below. (If you do have such knowledge,
state the name and address of the person, whether that person has physical custody, is claiming custody
rights, or is claiming visitation rights, and the name of the child involved.)
______________________________________________________________________________________
______________________________________________________________________________________
______________________________________________________________________________________

7. Mother’s mailing address is: _______________________________________________________________

8. Father’s mailing address is: _______________________________________________________________

9. a) The minor child(ren) affected or of this action are:

NAME BIRTHDATE BIRTHPLACE

______________________________________________________________________________________
______________________________________________________________________________________
______________________________________________________________________________________
______________________________________________________________________________________

b) All the children have resided together at the following locations during the last five years:

NAME AND PRESENT
ADDRESS OF PERSON
DATES OF ADDRESS OF CHILD HAVING PHYSICAL CUSTODY RELATION
RESIDENCE DURING PERIOD DURING RESIDENCE PERIOD TO CHILD

___________________________________________________________________________________
___________________________________________________________________________________
___________________________________________________________________________________
___________________________________________________________________________________

NOTE: If any of the children have lived separately,
give specific information for that child on an additional page.

________________________________________
Plaintiff Defendant

SUBSCRIBED AND SWORN to before me this _____ day , 20 __
by ___________________________________________________.

_________________________________________
My Commission Expires: Notary Public

____________________

2 dwcpetition-nottice re health ins.info
Revised 07.23.09

———————– Page 27———————–

Name: ___________________________________

Address: _________________________________

City, State, ZIP: ____________________________

Daytime Telephone No: ______________________

Representing Self, Without a Lawyer

ARIZONA SUPERIOR COURT, PIMA COUNTY

______________________________________ Case No. _________________
Petitioner
and
CONFIDENTIAL
______________________________________ SENSITIVE DATA FORM
Respondent

A. Personal Information:
Name Date of Birth Social Security Number
Petitioner: __________________________________ _______________ ___________________
Respondent: ________________________________ _______________ ___________________
Child: ______________________________________ _______________ ___________________
Child: ______________________________________ _______________ ___________________
Child: ______________________________________ _______________ ___________________
Child: ______________________________________ _______________ ___________________

B. Financial account numbers (including credit cards, financial institution accounts, investments, debts):
Financial Institution Type of Account Name(s) on Account Account #
________________________ ________________ ______________________ _____________
________________________ ________________ ______________________ _____________
________________________ ________________ ______________________ _____________
________________________ ________________ ______________________ _____________
________________________ ________________ ______________________ _____________
________________________ ________________ ______________________ _____________

C. Pension and retirement accounts (including IRAs, 401ks):
Financial Institution Type of Account Name(s) on Account Account #
________________________ ________________ ______________________ _____________
________________________ ________________ ______________________ _____________
________________________ ________________ ______________________ _____________

D. Life insurance policies:
Insurance Company Type of Policy Name(s) on Policy Policy #
________________________ ________________ ______________________ _____________
________________________ ________________ ______________________ _____________

1 dwcpetition-sensitive information.form
Revised 07.23.09

———————– Page 28———————–

NOTICE

In your property settlement agreement or decree of dissolution or legal separation, the court may assign
responsibility for certain community debts to one spouse or the other. Please be aware that a court order that does
this is binding on the spouses only and does not necessarily relieve either of you from your responsibility for these
community debts. These debts are matters of a contract between both of you and your creditors (such as banks,
credit unions, credit card issuers, finance companies, utility companies, medical providers and retailers).

Since your creditors are not parties to this court case, they are not bound by court orders or any agreements you and
your spouse reach in this case. On request, the court may impose a lien against the separate property of a spouse
to secure payment of debts that the court orders the spouse to pay.

You may want to contact your creditors to discuss your debts as well as the possible effects of your court case on
your debts. To assist you in identifying your creditors, you may obtain a copy of your spouse’s credit report by
making a written request to the court for an order requiring a credit reporting agency to release the report to you.
Within thirty days after receipt of a request from a spouse who is party to a dissolution of marriage or legal separation
action, which includes the court and case number of the action, creditors are required by law to provide information
as to the balance and account status of any debts for which the requesting spouse may be liable to the creditor. You
may wish to use the following form, or one that is similar to contact your creditors.

*************************************************************************************************************************************

Creditor Notification

Date: ___________________

Creditor Name: ________________________________________________________________________________

Creditor Address: ______________________________________________________________________________

Account #: _____________________________

Within thirty days after receipt of this notice, you are requested to provide the balance and account status of any debt
identified by account number for which the requesting party may be liable to you.

Name: _______________________________________________________________________________________

Address: _____________________________________________________________________________________

Signature: ____________________________________________________________________________________

1 dwcpetition-creditor notification.info
Revised 07.23.09

———————– Page 29———————–

PIMA COUNTY SUPERIOR COURT
SELF-SERVICE PACKET

INSTRUCTIONS ON FILING THE DIVORCE PAPERS WITH THE COURT

STEP 1: MAKE COPIES (in addition to the original) OF THE FOLLOWING COMPLETED DOCUMENTS

Domestic Relations/Probate Cover Sheet – 1 copy
Summons – 2 copies
Preliminary Injunction – 2 copies
Petition for Dissolution of Marriage – 2 copies
Notice of Right to Convert Health Insurance – 1 copy
Completed Affidavit Re: Minor Children – 2 copies
Sensitive Information Sheet – 1 copy
Creditor’s Notification – 1 copy
Order to Complete Course in Domestic Relations Education on Children’s Issues – 2 copies

STEP 2: SEPARATE DOCUMENTS INTO 3 SETS AS FOLLOWS:

(This will usually be done after the deferral/waiver of fees/costs has been approved.)

SET 1 – TO CLERK OF COURT: SET 2 – COPIES FOR SPOUSE:

Domestic Relations Cover Sheet Summons
Summons Preliminary Injunction
Preliminary Injunction Petition for Dissolution of Marriage
Petition for Dissolution of Marriage Notice of Right to Convert Health Insurance
Affidavit Re: Minor Children Completed Affidavit Re: Minor Children
Notice of Right to Convert Health Insurance Creditor Notification
Sensitive Information Sheet Order to Complete Course in Domestic
Relations Education on Children’s Issues

SET 3 – YOUR COPIES: Same as Spouse’s
plus Sensitive Information Sheet

STEP 3: FILING THE PAPERS AT THE COURT:

FILE THE PAPERS AT:
The Clerk of the Superior Court
First Floor
SUPERIOR COURT BUILDING
110 West Congress
Tucson, Arizona 85701

FROM 8AM-9PM, MONDAY – FRIDAY (except legal holidays). Arrive at the Court at least one hour
before it closes.

NOTICE: There is a filing fee for all Petitions and there are Service Fees. You may request a
Deferral or Waiver of the filing fees (and certain Service Fees) at the time you file
your papers with the Clerk of the Court.

GET BACK: MAKE SURE YOU GET BACK THE FOLLOWING:

Your Original Summons
Your Set of Copies
Spouse’s Set of Copies

STEP 4: Now you will serve the court papers on your spouse.

GO TO THE PACKET ENTITLED “Service of Papers on the Other Party”.

1 dwcpetition-instructions for filingl.info
Revised 07.23.09

———————– Page 30———————–

Name: ___________________________________

Address: _________________________________

City, State, ZIP: ____________________________

Daytime Telephone No: ______________________

Representing Self, Without a Lawyer

ARIZONA SUPERIOR COURT, PIMA COUNTY

______________________________________ Case No. _________________
Petitioner
and
REQUEST FOR
______________________________________ PROTECTED ADDRESSS
Respondent

I reasonably believe that physical or emotional harm may result to me or my minor child(ren) if my address is not
protected from disclosure, and I request that the court order that my address be protected from public disclosure, for
the following reasons:

[ ] I have a valid Order of Protection against a party in this case issued by the following court (a copy is attached if
available):

__________________________________________________________________________________________

[ ] I have a valid Order of Protection against a party in this case issued by this court:

__________________________________________________________________________________________

[ ] I have a valid Order of Protection against a person not involved in this case issued by the following court (a copy
is attached if available):

__________________________________________________________________________________________

[ ] I do not have a valid Order of Protection, but want my address protected for the following reasons:

__________________________________________________________________________________________

My address is currently unknown to the other party. I have listed my address on a separate sheet of paper for court
use.

I understand that I have a continuing duty to provide the clerk of the court with a current and correct mailing address
where I can be served with process until one of the following events stated in Rule 7(D), Arizona Rules of Family Law
Procedure, occurs.

__________________________________ _______________________________________________
Date Requestor’s Signature

1 dwcpetition-request for protected address
Revised 07.23.09

———————– Page 31———————–

PERSON WHOSE ADDRESS IS PROTECTED: _______________________________________________
[ ] Petitioner [ ] Respondent
ADDRESS TO BE PROTECTED:

Street: _________________________________________________________________________

City: _________________________________________________________________________

State, Zip Code: _________________________________________________________________________

Telephone Number: _________________________________________________________________________

2 dwcpetition-request for protected address
Revised 07.23.09

———————– Page 32———————–

ARIZONA SUPERIOR COURT, PIMA COUNTY

______________________________________ Case No. _________________
Petitioner
and
ORDER FOR
______________________________________ PROTECTED ADDRESS
Respondent

Upon request of [ ] Petitioner [ ] Respondent, and good cause appearing,

IT IS ORDERED that:

The address of [ ] Petitioner [ ] Respondent shall be protected from public disclosure until further order of this court.

The Clerk of the Court shall protect the address of [ ] Petitioner [ ] Respondent from public disclosure until further
order of this court.

The Clerk and the parties hereto shall comply with the requirements of Rule 7, Arizona Rules of Family Law
Procedure, as follows:

Any person required under these rules to serve a response or other document upon a person whose address is
ordered protected from disclosure under this rule may serve the same by delivering true and correct copies of the
documents to be served, together with the proper fee established by administrative order to cover the cost of service,
to the clerk of the court. The clerk shall promptly mail the documents by regular first-class to the most recent
protected address provided to the clerk, and service shall be deemed complete upon mailing. The clerk shall
promptly file a written statement verifying the documents that were mailed and the date of mailing to the protected
address signed by the clerk or deputy clerk who mailed the documents. All documents mailed to a protected address
shall bear the clerk’s return address, and a notation of any process returned as undeliverable shall be made in the
court file.

_______________________________ ______________________________________________________
Date Judicial Officer

1 dwcpetition-order for protected address.form
Revised 07.23.09

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