Family Court Sensitive Data Coversheet With Children (Confidential Record)

Person Filing: Address (if not protected): City, State, Zip Code: Telephone: Email Address: ATLAS Number: Lawyer's Bar Number: Representing Self, without a Lawyer or For Clerk's Use Only Attorney for Petitioner OR Respondent SUPERIOR COURT OF ARIZONA IN MOHAVE COUNTY Case No. Petitioner ATLAS No. Respondent FAMILY COURT / SENSITIVE DATA COVERSHEET WITH CHILDREN (CONFIDENTIAL RECORD) Fill out. File with Clerk of Court. Social Security Numbers should appear on this form only and should be omitted from other court forms. Access Confidential pursuant to ARFLP 43(G)(1). Petitioner Respondent A. Personal Information: Name Gender Date of Birth (Month/Day/Year) Social Security Number Male or Female Male or Female WARNING: DO NOT INCLUDE MAILING ADDRESS ON THIS FORM IF REQUESTING ADDRESS PROTECTION Mailing Address City, State, Zip Code Contact Phone Email Address Current Employer Name Employer Address Employer City, State, Zip Code Employer Telephone Number Employer Fax Number B. Child(ren) Information: Child Name Gender Child Social Security Number Child Date of Birth C. Type of Case being filed - Check only one category. *Check only if no other category applies Dissolution (Divorce) Paternity *Legal Decision Maker Legal Separation (Custody)/Visitation Annulment *Child Support Order of Protection Other Interpreter Needed: Yes No If yes, what language? Register Foreign Order DO NOT COPY THIS DOCUMENT. DO NOT SERVE THIS DOCUMENT TO THE OTHER PARTY. © Superior Court of Arizona in Mohave County ALL RIGHTS RESERVED SDS DRSDS10f-c-110315 Page 1 of 1 American LegalNet, Inc. www.FormsWorkFlow.com