Revised: 08/13/09

Easy asEst. Custody, Visitation, & Child Support for

                  Non-Married People w/ Children

Payment can be made through our payment center online or at the time of you initial phone consultation.

 Section I - Personal & Contact Information:

 

*Name   (Example John Public Doe)

Home phone Work phone   Cell phone    

(Example 602-896-9020)

*Email                            

Mailing address:

Street    Apt.

City  State  Zip

Date of birth  (Example 12-01-1963)

Social Sec. No. (Example 123-04-8789)

Who did you speak with from our office prior to completing this questionnaire?

Section 2 - Other Party's Contact Information:

*Name    (Example John Public Doe)

Home phone Work phone  Cell phone

(Example 602-896-9020)

Mailing or severable address:

Street  Apt.

City  State   Zip

Date of birth  (Example 12-01-1963)

 Social Sec. No. (Example 123-04-8789)

Section 3- Child information

  Child's Name    
Child #1 
Child #2
Child #3
Child #4
  Date of Birth Place of Birth (City and State) Social Security Number
Child #1

 
Child #2

 
Child #3

 
Child #4

 

 

 

Section 4 - Jurisdiction Information

Select all that apply:

Other party lives in Arizona.

Other party will be served in Arizona.

Other party has agreed to have this case heard in Arizona.

Other party lived in Arizona with the child at some point in time.

Other party provided pre-birth expenses and/or support.

The child(ren) lived in Arizona as a result of the acts or directions of the other party.

You and the other party had sexual intercourse in Arizona which resulted in the child's birth.

Other party signed a birth certificate for this (these) child(ren).

Section 5 - Paternity Information

Select all that apply.

Father signed an Affidavit of Paternity.

Father's name is on the birth certificate which is signed by mother and father.

A DNA test show that either you or the other party is the father.

Both mother and father were not married to each other at anytime during the 10 months before the child was born.

Both mother and father were not living together but had sexual intercourse at the probable date of the conception of the child.

Section 6 - Paternity Information (cont)

Select one:

If you do have an order of paternity, what is the date?

If you do have an order of paternity, what is the name of the court it is from?

If you do have an order of paternity, what is the case number?

Section 7 - Information about Child Support for Child(ren)

Select one:

Section 8 - Financial Information

Based upon the figures below. Discount Divorce will calculate the child support as per Arizona Child Support Guidelines as required by law.  Ariz.Rev.Stat. 25-320.

Note: If you and the other party have agreed upon a child support amount please let us know when we contact you.

Father's gross monthly income:  $  

Mother's gross monthly income: $

Day care cost (if any) $    

Medical insurance premium (if any) $  

What percentage of uninsured medical expense will you be responsible for? %

     If you leave this blank, then the percentage will be calculated proportionate to both incomes.

What percentage of visitation travel related expenses will you be responsible for?   %

     If you leave this blank, then the percentage will be calculated proportionate to both incomes.

Does either you or the other party have minor children residing with them from another relationship?

If, yes list their names, dates of birth, and who they live with (myself or my spouse)

 

(Example John Public Doe, 07/30/98)

Employment information of NON-Custodial Parent:

Employer  or  Unemployed or   Self-Employed

Address   (Street, City, State, & Zip Code)       

Section 9-  Custody

Select one:

What are the different types of custody?

 Shared custody option not recommended for parents living more than 25 mile apart.

If you selected No visitation you are telling the court that the other parent is an EXTREME Danger to the child(ren).

 If Supervised visitation was checked - Why do you want supervised visitation?  Check all that apply:

      Drug abuse  Alcohol abuse  Anger Management Issues and/or  Flight risk (parent will run off with the children)

 

Section 10- Address of the Child(ren)

List all address or major cross roads for where the child(ren) resided for the last 5 years. Please include month and year. 

Example: 3 East Oak, Phoenix, AZ from 03/05 to 07/07 with mother

                                    or

19th Ave. & Bell Rd., Phoenix, AZ from 03/05 to 07/07 with mother    

Address   From   Until    
    Present  
     
     
     
     

 

Section 11 - Process Service

We must provide  a copy of the legal documents to the other party AFTER they have been filed with the Court.  What is the single best way to do this? 

Select one:

Option 1 The other party  will come into your office and sign them.

Fee: FREE

Option 2 I will take other party a copy of the documents.

Fee: FREE

Option 3 Send the documents by certified mail.

Fee: $25

Option 4 The other party will not sign anything. They must be served by a Process Server.

Fee: $95 Metro Phoenix / $150 Non-Metro Phoenix

Do I need a Process Server? How does Process Service work?

Option 5 I do not know the whereabouts of other party.

Fee: $100

How does Publication / Newspaper Divorce work?

If you stated you do NOT know the whereabouts of other party,

then when was the last time you seen them? (Example 05-01-1993)

Section 12 -Other information or comments  

Section 13-Payment Options

Discount Divorce will immediately begin work on your case as soon as your initial phone consultation is complete and your payment is received.

Pricing and cost information:

Discount Divorce will call you between the hours of 9AM and 4PM, Monday thru Friday.

What is the best time to reach you at during the hours listed above? until on

Payment & Acknowledgement

All costs will be discussed with you in advance, and we will not proceed or charge your card until you instruct us to do so.

Card number requiredNote: You are not obligating yourself financially by submitting this form.

*Number *Exp. Date *Type of Card

Terms of Service

I acknowledge that I have read the "Terms of Service" and agree and understand them.

*Applicant Name/Signature: All information contained herein is true and correct

*Date (mm/dd/yyyy):