Family Court Cover Sheet For Use With Minor Children - Superior Court Of Mohave County, Arizona

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For Clerk’s Use Only
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SUPERIOR COURT OF ARIZONA
MOHAVE COUNTY
ATLAS Number(s) (if applicable)
_______________________________________
Case No._______________________________
FAMILY COURT COVER SHEET
***NOTE***
For Use WITH Minor Children
(Check only one):
SOCIAL SECURITY NUMBER MUST
Dissolution (Divorce)
BE PROVIDED. IT CAN BE OMITTED
Legal Separation
FROM THIS DOCUMENT AS LONG AS
Annulment
YOU INCLUDE IT ON THE CONFIDENTIAL
Order of Protection
SENSITIVE DATA FORM
Paternity
* Legal Decision Making / Parenting Time
* Child Support
Other ___________________________
* Check only if no other category applies
INSTRUCTIONS:
•
You must provide the following information about yourself and the other party.
•
Type or print neatly in black ink.
•
If more room is needed for children or Petitioner/Respondent, please attach a separate page.
Information About the Petitioner:
Information About the Respondent
Name:
Name:
Address:
Address:
City, State, Zip:
City, State, Zip:
Home Phone #:
Work Phone #
Home Phone #:
Work Phone #
Cell Phone/Pager
Date of Birth
Cell Phone/Pager
Date of Birth
Social Security
E-Mail address:
Social Security #
E-Mail address:
#
(***SEE NOTE***)
(***SEE NOTE***)
Lawyer’s Name and Bar Number: ______________________________________________________________
(Provide this information only if YOU have an Attorney)
Do you need an Interpreter
Yes
No
If yes, what language: ___________________________
Information About the Children:
Name
Date of Birth
Social Security
# (***SEE NOTE***)
Revised: 1/1/2013
Page 1 of 1

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