Superior Court of Arizona in Yavapai County Page 1 of 12 DRDC10f
January 2020
Name:
UMailingU Address:
UDaytimeU Telephone:
Representing Self, Without a Lawyer
IN THE S
UPERIOR COURT OF ARIZONA, YAVAPAI COUNTY
In re the marriage of U1300DO
ATLAS #
PETITION FOR DISSOLUTION
Petitioner OF A NON-COVENANT MARRIAGE
and
WITH MINOR CHILDREN
[ ] and Request for Order of Paternity
Respondent
STATEMENTS TO THE COURT, UNDER OATH
1. INFORMATION ABOUT ME, THE PETITIONER
Name: Date of Birth:
Address:
Occupation:
How long I, the Petitioner, have lived in Arizona: years months.
[ ] The Petitioner is enlisted in the military, and [ ] has OR [ ] has not been deployed for at least
one day during the past 6 months.
2. INFORM
ATION ABOUT MY SPOUSE, THE RESPONDENT
Name: Date of Birth:
Address:
Occupation:
How long my spouse, the Respondent, has lived in Arizona: years months.
[ ] The Respondent is enlisted in the military, and [ ] has OR [ ] has not been deployed for at least
one day during the past 6 months.
3. INFORMATION ABOUT OUR MARRIAGE
Date of Marriage: city and state or country where married:
[ ] We do not have a covenant marriage.
4. 90-DAY R
ESIDENCY REQUIREMENT
[ ] I have, and/or [ ] my spouse has, lived or been stationed while a member of the Armed Forces, in
Arizona for at least 90 days at the time this Petition is filed. (IF THIS STATEMENT IS NOT TRUE,
YOU CANNOT FILE FOR DIVORCE UNTIL IT BECOMES TRUE.)
For Clerk’s Use Only
Superior Court of Arizona in Yavapai County Page 2 of 12 DRDC10f
January 2020
INFORMATION ABOUT PROPERTY AND DEBTS:
5a. P
ROPERTY ACQUIRED DURING THE MARRIAGE: (Community Property) Check one box.
[ ] My spouse and I did not acquire any community property during the marriage. Go on to 5b.
[ ] My spouse and I acquired community property during our marriage, and we should divide it as
follows: (List the property and the value of the property, and check the box to tell the Court who
you believe should get the property.)
DESCRIPTION OF PROPERTY/ HUSBAND WIFE SELL &
VALUE OF PROPERTY: SPLIT
[
] Real estate address: [ ] [ ] [ ]
Legal Description:
R
eal estate address: [ ] [ ] [ ]
Legal Description:
[
] Household furniture and appliances:
[ ] [ ] [ ]
[ ] [ ] [ ]
[ ] [ ] [ ]
[ ] [ ] [ ]
[ ] [ ] [ ]
[ ] [ ] [ ]
[ ] [ ] [ ]
[ ] [ ] [ ]
[ ] [ ] [ ]
[ ] [ ] [ ]
[ ] [ ] [ ]
[ ] [ ] [ ]
[ ] [ ] [ ]
[
] Household furnishings:
[ ] [ ] [ ]
[ ] [ ] [ ]
[ ] [ ] [ ]
Superior Court of Arizona in Yavapai County Page 3 of 12 DRDC10f
January 2020
HUSBAND WIFE SELL &
SPLIT
[ ] [ ] [ ]
[ ] [ ] [ ]
[ ] [ ] [ ]
[ ] [ ] [ ]
[ ] [ ] [ ]
[ ] [ ] [ ]
[ ] [ ] [ ]
[
] Other items:
[ ] [ ] [ ]
[ ] [ ] [ ]
[ ] [ ] [ ]
[ ] [ ] [ ]
[
] Pension/retirement fund/profit sharing/ stock plan/401K:
[ ] [ ]
[ ] [ ]
[ ] [ ]
[ ] [ ]
[
] Motor vehicles:
Make [ ] [ ] [ ]
Model
VIN
Lien Holder
Make [ ] [ ] [ ]
Model
VIN
Lien Holder
5b. PR
OPERTY ACQUIRED BEFORE MARRIAGE (Separate Property): (check all boxes that apply)
[ ] I do not have any property that I brought into the marriage.
[ ] My spouse does not have any property that he or she brought into the marriage.
[ ] I have property that I brought into the marriage. I want this property awarded to me as described
it below:
[ ] My spouse has property that he or she brought into the marriage. I want this property awarded
to my spouse as described below:
Superior Court of Arizona in Yavapai County Page 4 of 12 DRDC10f
January 2020
Separate Property: (List the property and the value of the property, and check the box to tell the
Court who should get the property.)
DESCRIPTION OF PROPERTY/ HUSBAND WIFE
VALUE OF PROPERTY:
[ ] [ ]
[ ] [ ]
[ ] [ ]
[ ] [ ]
6a. DE
BTS INCURRED DURING THE MARRIAGE:
[ ] My spouse and I did not incur any community debts during the marriage.
[ ] We should divide the responsibility for the debts incurred during the marriage as follows:
DESCRIPTION OF DEBT/ HUSBAND WIFE
AMOUNT OF DEBT:
[ ] [ ]
[ ] [ ]
[ ] [ ]
[ ] [ ]
[ ] [ ]
[ ] [ ]
[ ] [ ]
[ ] [ ]
[ ] [ ]
6b. SEPARATE DEBTS: (check all boxes that apply)
[ ] My spouse and I do not have any debts that were incurred prior to the marriage, OR
[ ] I have separate debt that I incurred prior to the marriage that should be paid by me as described
below:
[ ] My spouse has separate debt that he or she or incurred prior to the marriage that should be paid
by my spouse as described below:
DESCRIPTION OF DEBT/ HUSBAND WIFE
AMOUNT OF DEBT:
[ ] [ ]
[ ] [ ]
[ ] [ ]
[ ] [ ]
[ ] [ ]
7. T
AX RETURNS:
After the Judge or Commissioner signs the Decree of Dissolution of Marriage (Divorce), we will pay
federal and state taxes as follows:
[ ] For previous years (the years we were married, not including the year the decree is signed), th
e
par
ties will file joint federal and state income tax returns. The parties will hold the other harmless
from half of all additional income taxes, if any, and other costs, and each will share equally in any
Superior Court of Arizona in Yavapai County Page 5 of 12 DRDC10f
January 2020
refunds
[
] For the calendar year (the year that the decree is signed) and all future calendar years, each
party will file separate federal and state income tax returns. Each party will give the other party
all necessary documentation to do so.
8. SPOUSAL MAINTENANCE (ALIMONY) (check the box that applies to you):
[
] Neither party is entitled to Spousal Maintenance (alimony), OR
[ ] Petitioner OR [ ] Respondent is entitled to Spousal Maintenance because: (Check one or more
of the boxes below that apply. At least one reason 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 for a child(ren) whose age or condition is such that the 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 or 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 or has significantly reduced that spouse’s income or
career opportunities for the benefit of the other spouse. AND
[ ] Spousal maintenance shall be modifiable in accordance with Arizona law, OR
[ ] The parties acknowledge that the circumstances of their futures are unknown, but each desires
that this maintenance award not be modifiable in the future for any reason.
9. C
HILD(REN) OF THE PARTIES WHO ARE LESS THAN 18 YEARS OLD:
The following child(ren) are under age 18 and were born during the marriage or adopted by me and
my spouse: (attach extra pages if necessary)
Child’s Name:
Birthdate:
Address:
Length of time at address:
Names and addresses of persons lived with for the past five (5) years:
Present addresses of person(s) lived with:
[ ] The [ ] Petitioner OR [ ] Respondent is not the biological or adoptive parent.
Superior Court of Arizona in Yavapai County Page 6 of 12 DRDC10f
January 2020
Child’s Name:
Birth date:
Address:
Length of time at address:
Names and addresses of persons lived with for the past five (5) years:
Present addresses of person(s) lived with:
[ ] The [ ] Petitioner OR [ ] Respondent is not the biological or adoptive parent.
Child’s Name:
Birth date:
Address:
Length of time at address:
Names and addresses of persons lived with for the past five (5) years:
Present addresses of person(s) lived with:
[ ] The [ ] Petitioner OR [ ] Respondent is not the biological or adoptive parent.
Child’s Name:
Birth date:
Address:
Length of time at address:
Names and addresses of persons lived with for the past five (5) years:
Present addresses of person(s) lived with:
[ ] The [ ] Petitioner OR [ ] Respondent is not the biological or adoptive parent.
The following child(ren) are under age 18 and were born prior to the marriage and are common to me
and my spouse: (attach extra pages if necessary)
Child’s Name:
Birth date:
Address:
Length of time at address:
Names and addresses of persons lived with for the past five (5) years:
Present addresses of person(s) lived with:
Superior Court of Arizona in Yavapai County Page 7 of 12 DRDC10f
January 2020
Child’s Name:
Birth date:
Address:
Length of time at address:
Names and addresses of persons lived with for the past five (5) years:
Present addresses of person(s) lived with:
10. LEGAL DECISION-MAKING OR PARENTING TIME CASES INVOLVING THE MINOR
CHILD(REN):
[ ]
I HAVE [ ] I HAVE NOT been a party or a witness in court, in this state or any other state,
involving the legal decision-making or parenting time of any child(ren) named above. (If so, explain
below, using extra pages if necessary.)
Name of child:
Court state: Court location:
Court case number: Status:
How the child is involved:
Summary of any court order:
11. P
ENDING/PAST CASES RELATED TO MINOR CHILD(REN): (check one box)
[
] I DO [ ] I DO NOT know of any court case, in this state or any other state, that could affect this
case, including enforcement, domestic violence, protective orders, drugs, sexual offenses, termination
o
f parental rights and adoptions. (If so, explain below, using extra pages if necessary.)
Court state: Court location:
Court case number: Status:
Nature of the proceeding:
Date of conviction:
12. L
EGAL DECISION-MAKING OR PARENTING TIME CLAIMS OF ANY OTHER PERSON: (Check
one box)
[
] I KNOW [ ] I DO NOT KNOW the name and address of any person, other than the Petitioner or
the Respondent, who has legal decision-making for the child(ren) or claims rights of legal decision-
making, or parenting time of any child(ren) named above. (If so, explain below, using extra pages if
necessary.)
Name of each child:
Name of person with the claim:
Address of person with the claim:
Nature of the claim:
Superior Court of Arizona in Yavapai County Page 8 of 12 DRDC10f
January 2020
13. PREGNANCY AND PATERNITY:
[ ] Wife is not pregnant, OR
[ ] Wife is pregnant: Due date AND,
[ ] The Petitioner and Respondent are the parents of the child, OR
[ ] Petitioner is not the parent of the child, OR
[ ] Respondent is not the parent of the child.
[ ] A child or children was/were born before the marriage. The husband is the father of that
child/those children named below:
14. W
RITTEN AGREEMENTS, CHECK ONLY IF TRUE:
[
] For our child(ren), my spouse and I have a written agreement signed by both of us about:
[ ] Legal decision-making;
[ ] Parenting time;
[ ] Child support.
[ ] My spouse and I have a written agreement not related to the child(ren) and signed by both of us
about
.
[ ] I am filing the ORIGINAL Agreement.
15. [ ] The Attorney General's office is involved in this case (TANF, IV-D, etc.).
O
THER STATEMENTS TO THE COURT UNDER OATH: You must tell the court the truth. Lying to the
court is a crime and the court can punish you for lying. To file for divorce, you must be able to tell the court
that the following statements are true. If the statements are not true, you cannot file for divorce until the
statements are true. Check the box in front of each statement if the statement is true.
STATUS OF MARRIAGE AND CONCILIATION:
[
] TRUE: My marriage is irretrievably broken and there is no reasonable prospect of reconciliation.
(My marriage is over.)
[ ] TRUE: The conciliation requirements under Arizona law, A.R.S. 25-381.09 either do not apply or
have been met.
[ ] TRUE: This court has jurisdiction to decide child legal decision-making matters under Arizona
law.
REQUESTS TO THE COURT:
1. DISSOLUTION (DIVORCE):
[ ] Dissolve the parties’ marriage and return each party to the status of a single person;
2. NAMES:
Restore [ ] wife [ ] husband to her or his former name of .
WARNING: If you are not the person who is requesting to have your former name restored, the
cour
t must have a written request from the party who wants his or her name restored to
change the name.
Superior Court of Arizona in Yavapai County Page 9 of 12 DRDC10f
January 2020
3. SPO
USAL MAINTENANCE (ALIMONY):
[ ] Neither party shall pay spousal maintenance (alimony) to the other party, OR
[ ] Petitioner OR [ ] Respondent is ordered to pay the other party the sum of $
per month spousal maintenance BEGINNING AFTER THE
Decree is signed. Each payment shall be made by the first day of each month thereafter and
shall continue until [ ] the receiving party is remarried or deceased OR
[ ] until (date) . All payments shall be made through the Clerk of Court
by automatic wage assignment until all required payments have been made under the Decree.
[ ] In accordance with the parties’ agreements,
[ ] The spousal maintenance award shall be modifiable in accordance with Arizona law,
OR
[ ] The spousal maintenance award shall NOT be modifiable for any reason.
4. COMMUNITY PROPERTY:
[ ] Make a fair and equitable division of all community property as requested in this petition.
5. COMMUNITY DEBTS:
[ ] Order each party to pay community debts as requested in the 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 partiesseparation on
.
6. SEPARATE PROPERTY/DEBT:
[ ] Award each party his or her separate property.
[ ] Order each party to pay his or her separate debt.
7. PATERNITY: Declare the husband to be the father of the following named child(ren) born before the
m
arriage and (optional) change the legal name of those children to the name listed below:
Current legal name Change legal name to:
8. AWARD CHILD LEGAL DECISION-MAKING as follows:
[ ] SOLE LEGAL DECISION-MAKING: Sole legal decision-making for the minor child(ren)
awarded to [ ] Petitioner or [ ] Respondent.
OR
[ ] JOINT LEGAL DECISION-MAKING: Petitioner and Respondent agree to act as joint legal
decision-makers for the minor child(ren). AND
[ ] Domestic violence has not occurred during this relationship;
OR
[ ] Domestic violence has not been significant. However, domestic violence has occurred as
described in the Petition for Order of Protection(s) filed or
as described below:
Superior Court of Arizona in Yavapai County Page 10 of 12 DRDC10f
January 2020
OR
[ ] Joint legal decision-making is in the best interest of the child(ren) even though domestic
violence has occurred because:
Furthermore, the [ ] Petitioner AND/OR [ ] Respondent has/have taken classes, participated
in counseling or taken steps to avoid further domestic violence as described below:
9. PARENTING TIME: Parenting time is requested as follows:
1. [ ] Reasonable parenting time pursuant to the attached Parenting Plan;
2. [ ] Supervised parenting time. Supervised parenting time is in the best interest(s) of
the child(ren) because unrestricted parenting time would seriously endanger the
child(ren)'s physical, mental, moral or emotional health. These facts support my
claim:
[ ] Name of person who will supervise:
[ ] The cost of supervised parenting time shall be paid by [ ] Petitioner OR
[ ] Respondent OR [ ] shared equally.
3. [ ] No parenting time (check and explain ONLY if you want the other party to have
no parenting time): No parenting time between the child(ren) and the other party is
in the best interests of the child(ren) because any parenting time would seriously
endanger the child(ren)'s physical, mental, moral or emotional health.
These facts support my claim:
Superior Court of Arizona in Yavapai County Page 11 of 12 DRDC10f
January 2020
10
. CHILD SUPPORT: There is no child support order for the minor child(ren) and the court should order
child support in this case.
[ ] O
rder child support be paid by me or the other party in an amount as determined by the Court
under the Arizona Child Support Guidelines and according to the Parent’s Worksheet filed with this
matter.
[
] Order an amount of child support that deviates from the Guidelines because:
[
] Application of the Guidelines is inappropriate or unjust because:
_____________________________________________________________________________
_____________________________________________________________________________
[
] The parties signed an agreement free of duress and coercion, with knowledge of the amount
of support that would have been ordered by the Guidelines but for the agreement. A copy of the
agreement is attached.
[
] Order [ ] Petitioner [ ] Respondent to pay past support in an amount determined using the
Arizona Child Support Guidelines, taking into account any temporary or voluntary/direct support
payments made, the period beginning:
[
] the date this petition was filed until current child support is ordered,
OR,
[
] 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.
[
] Petitioner [ ] Respondent made temporary or voluntary/direct support payments that need to be
taken into account if past support is requested.
Child support payments to begin on the first day of the month after the judge or commissioner
signs the __________ a final order. All payments, plus the statutory handling fee, to be paid through
the Support Payment Clearinghouse. P.O. Box 52107, Phoenix, AZ 85072-2107 by income
withholding order.
1
1. HEALTH, MEDICAL, DENTAL INSURANCE AND HEALTH CARE EXPENSES FOR CHILD(REN):
Order that [ ] Petitioner or [ ] Respondent shall pay for health, medical, dental insurance coverage
for the child(ren) under the age of 18 years, and that [ ] Petitioner or [ ] Respondent shall pay for all
reasonable unreimbursed medical, dental, health-related expenses incurred for the child(ren) i
n
pr
oportion to their respective incomes as described on the Child Support Worksheet, which shall
be
f
iled with this Petition.
1
2. TAX EXEMPTION: The parties will claim the child(ren) as income tax dependency exemptions
on
f
ederal and state income tax returns and as allowed by federal and state tax laws as follows:
Parent entitled to claim Name of child Current tax year Later tax years
[ ] Mother [ ] Father
[ ] Mother [ ] Father
[ ] Mother [ ] Father
[ ] Mother [ ] Father
Superior Court of Arizona in Yavapai County Page 12 of 12 DRDC10f
January 2020
1
3. OTHER ORDERS I AM REQUESTING (Explain request here):
OATH AND VERIFICATION
STATE OF )
County of ) ss
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.
Signature
SUBSCRIBED AND SWORN to before me this day of , 20 , by
.
My Commission Expires: NOTARY PUBLIC
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