© Superior Court of Arizona in Maricopa County DRSDS10f-c- 071519
ALL RIGHTS RESERVED Page 1 of 1
Person Filing:
Address (if not protected):
City, State, Zip Code:
Telephone:
Email Address:
ATLAS Number:
Lawyer’s Bar Number:
Representing Self, without a Lawyer or Attorney for Petitioner OR Respondent
SUPERIOR COURT OF ARIZONA
IN MARICOPA COUNTY
FAMILY DEPARTMENT SENSITIVE DATA
COVERSHEET WITH CHILDREN
(CONFIDENTIAL RECORD)
Fill out. File with Clerk of Superior Court. Social Security Numbers should appear on this form only and
should be omitted from other court forms. Access Confidential pursuant to ARFLP 43.1(f).
Male or Female
Male or Female
Date of Birth (Month/Day/Year)
Warning: DO NOT INCLUDE MAILING ADDRESS ON THIS FORM IF REQUESTING ADDRESS PROTECTION
Receive texts from Court to
contact phone number above?
Yes No texts Yes
No texts
Employer City, State, Zip Code
Employer Telephone Number
B. Child(ren) Information:
Child Social Security Number
C. Type of Case being filed: Mark only one (1) category below. (*) Mark this box only if no other case type applies.
Dissolution (Divorce)
Paternity
Legal Separation
Legal Decision-Making
Register Foreign Order
D. Do you need an interpreter? Yes or No. If Yes, what language? _____________________
DO NOT COPY this document. DO NOT SERVE THIS DOCUMENT to the other party.