Affidavit Regarding Minor Children
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For Clerk’s Use Only
Name of Person Filing:
___________________________________
Mailing Address:
___________________________________
City, State, and Zip Code:
___________________________________
Phone Number(s):
___________________________________
ATLAS Number (if applicable):___________________________________
State Bar Number (if applicable):_________________________________
Representing:
Self (Without Attorney) or
Attorney for:
Petitioner
Respondent
SUPERIOR COURT OF ARIZONA
MOHAVE COUNTY
Case Number: ________________________
(Name of Petitioner)
AFFIDAVIT REGARDING
MINOR CHILDREN
AND
(Name of Respondent)
NOTICE:
This “Affidavit Regarding Minor Children” is required for all legal decision making cases.
You must fill out this Affidavit completely, and provide accurate information. Use additional paper if
necessary. You must give copies of this Affidavit and all other required documents to the other party,
and to the judge.
1.
CHILDREN OF THE PARTIES WHO ARE UNDER 18 YEARS OLD.
The following
child(ren) are under age 18 and were born to, or adopted by, me and the other party.
Name
Name
Birthdate:
Age:
Birthdate:
Age:
Name
Name
Birthdate:
Age:
Birthdate:
Age:
2.
INFORMATION REGARDING WHERE THE CHILDREN UNDER 18 YEARS OLD
HAVE LIVED FOR THE LAST 5 YEARS.
Child’s Name:
Dates: From
To
Address:
Lived with:
City, State:
Relationship to Child:
Child’s Name:
Dates: From
To
Address:
Lived with:
City, State:
Relationship to Child:
Child’s Name:
Dates: From
To
Address:
Lived with:
City, State:
Relationship to Child:
3.
COURT CASES IN WHICH I HAVE BEEN A PARTY/WITNESS THAT INVOLVED
THE LEGAL DECISION MAKING / PARENTING TIME OF THE CHILD(REN).
(Check
one box.)
I have or
have not been a party/witness in court in this state or in any other state that
involved the legal decision making / parenting time of the child(ren) named above. (If so, explain on
separate paper. If not, go on.)
Page 1 of 2
Revised: 1/1/2013
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