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For Clerk’s Use Only
Name of Person Filing:
________________________________________
Mailing Address:
________________________________________
City, State, Zip Code:
________________________________________
Day/Evening Phone Number: ________________________________________
ATLAS Number (if applicable):_______________________________________
Representing:
Self, Without a Lawyer OR
Attorney for:
Petitioner
Respondent
SUPERIOR COURT OF ARIZONA
MOHAVE COUNTY
_________________________________________
Case Number:______________________________
(Name of Petitioner)
PETITION FOR DISSOLUTION OF A
NON-COVENANT MARRIAGE
AND
(DIVORCE) WITH CHILDREN
_________________________________________
(Name of Respondent)
STATEMENTS MADE TO THE COURT, UNDER OATH:
NOTE: *Social Security Number can be omitted if using Confidential Sensitive Data Form
1.
INFORMATION ABOUT ME, THE PETITIONER:
Name: __________________________________________________________________________________
Address:
Date of Birth__________________________
Social Security #___________________ (*Can be omitted if using the Confidential Sensitive Data Form)
Job Title: ________________________________________________________________________________
Starting with today, I the Petitioner have lived in Arizona for _________ years and/or ___________ months in a
row.
2.
INFORMATION ABOUT MY SPOUSE, THE RESPONDENT:
Name: __________________________________________________________________________________
Address: _____________________________________________Date of Birth_________________________
Social Security #___________________ (*Can be omitted if using the Confidential Sensitive Data Form)
Job Title: ________________________________________________________________________________
Starting with today, I the Respondent have lived in Arizona for __________ years and/or ___________months
in a row.
3.
INFORMATION ABOUT MY MARRIAGE:
Date of Marriage:__________________________
City and state or country where we were married:
We do not have a covenant marriage.
We do have a covenant marriage. (Warning: If you have a covenant marriage, you cannot use
this form. If you have questions about whether you have a covenant marriage, review your marriage
license, review the checklist in this packet, and see a lawyer for help.)
4.
90 DAY REQUIREMENT:
I OR
my spouse have lived, or have been stationed while a member of the Armed Forces, in Arizona for
at least 90 days before I filed this action. (WARNING: If this statement is not true, you cannot file your case
in Arizona.)
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Revised: 7/22/2015
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