Reset
For Clerk’s Use Only
Name of Person Filing:
_________________________________
Mailing Address:
_________________________________
City, State, Zip Code:
_________________________________
Phone Number(s):
_________________________________
ATLAS Number (if applicable):
_________________________________
Attorney Bar Number (if applicable): _________________________________
Representing
Self
Petitioner OR
Respondent
SUPERIOR COURT OF ARIZONA
MOHAVE COUNTY
______________________________________
Case Number:__________________________
Name of Petitioner (in original case)
PETITION TO MODIFY LEGAL
DECISION MAKING, PARENTING
AND
TIME and CHILD SUPPORT
______________________________________
Name of Respondent (in original case)
I,
am the
Petitioner or
Respondent or
Other
and make the following statements to the court, under oath:
(print your name)
GENERAL INFORMATION:
1.
Information about Me
Name:______________________________________________________________________________
Address: ____________________________________________________________________________
How I am related to child(ren) for whom the Legal Decision Making / Parenting Time Order should
be changed:
Mother or
Father or
Other: (explain) ____________________________________________
2.
Information about the Other Party
Name: _____________________________________________________________________________
Address:
How the other party is related to child(ren) for whom the Legal Decision Making / Parenting Time Order
should be changed:
Mother or
Father or
Other: (explain) ___________________________________________
3.
Information about the child(ren) for whom I want the Legal Decision Making /
Parenting Time Order changed:
Child’s Name: ______________________________
Birth date:______________
Age: ________
Child’s Name: ______________________________
Birth date:______________
Age: ________
Child’s Name: ______________________________
Birth date: ______________
Age: ________
Child’s Name: ______________________________
Birth date: ______________
Age: ________
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Revised: 1/30/2013