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Domestic Relations Case Filing Information Form
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Superior Court
County _____________________
Date Filed _____________
MM-DD-YYYY
Docket # ____________________
Plaintiff(s)
Defendant(s)
__________________________________
__________________________________
Last
First
Middle I. Suffix Prefix
Maiden
Last
First
Middle I. Suffix Prefix
Maiden
__________________________________
__________________________________
Last
First
Middle I. Suffix Prefix
Maiden
Last
First
Middle I. Suffix Prefix
Maiden
Plaintiff/Petitioner's Attorney
Pro Se
__________________________________
Bar # _________________
Last
First
Middle I.
Suffix
Check Case Type (one or more)
FAMILY VIOLENCE
Divorce (includes annulment)
Additional Information - Ex Parte Relief
Contested?
Yes No
Child Custody Issue?
Yes No
Did the initial pleading include a request for relief?
Child Support Issue?
Yes No
1. From alleged family violence?
Yes No
Separate Maintenance
2. Was ex parte relief requested?
Yes No
Adoption
Yes No
3. Was ex parte relief granted?
Paternity (includes legitimation)
Interstate Support Enforcement Action
Domestication of Foreign Custody Decree
OTHER
Family Violence Act Petition
Have the parties agreed to binding arbitration? Yes No
MODIFICATION
Have the parties reached a custodial agreement? Yes No
Modification - Custody, Visitation, or Parenting Time
If yes, check one:
Does the modification include a parent selection
Joint Custody
by a child who is at least 14 years old? Yes No
Joint Legal Custody
Modification - Child Support and Alimony
Joint Physical Custody
Modification - Child Support
Sole Custody to: ______________________
Modification - Alimony
Yes No
Financial Affidavit submitted?
CONTEMPT
Yes No
Child Support Forms submitted?
Contempt - Custody, Visitation, or Parenting Time
Contempt - Child Support and Alimony
Contempt - Child Support
Contempt - Alimony
Other Domestic Contempt
Other Domestic Relations Specify_______________________
___________________________________________________
___________________________________________________