L. R. Prac. Sup. Ct. 14 app A
YUMA COUNTY SUPERIOR COURT | Attachment C | ||||
DOMESTIC RELATIONS COVER SHEET AND POST ADJUDICATION PETITIONS' COVER | |||||
ARE YOU THE PETITIONER? | [] ARE YOU THE RESPONDENT? | [] | |||
CASE NUMBER________________________________ | |||||
Name | __________________ | Name | __________________ | ||
Mail Address | __________________ | Mail Address | __________________ | ||
City/St/Zip | __________________ | City/St/Zip | __________________ | ||
Telephone | __________________ | Telephone | __________________ | ||
SS# | _________________ | DOB_____________ | SS#__________ | DOB | |
Employer | __________________ | Employer | __________________ | ||
Address | __________________ | Address | __________________ | ||
City/St/Zip | __________________ | City/St/Zip | __________________ | ||
PETITIONER'S ATTORNEY | RESPONDENT'S ATTORNEY/PRO PER | ||||
Name | __________________ | Name | __________________ | ||
Address | __________________ | Address | __________________ | ||
City/St/Zip | __________________ | City/St/Zip | __________________ | ||
Telephone | __________________ | Telephone | __________________ | ||
State Bar # | __________________ | State Bar # | __________________ | ||
MINOR CHILDREN (For additional children use reverse of this form) | |||||
NAME | DATE OF BIRTH | GENDER | SOCIAL SECURITY NUMBER |
____________________________________________________ | |||
____________________________________________________ | |||
____________________________________________________ | |||
____________________________________________________ | |||
_________ | THIS CASE DOES HAVE A RELATED IV-D CASE | |||
_________ | THIS CASE DOES NOT HAVE A RELATED IV-D CASE | |||
_________ | THERE IS CURRENTLY A WAGE ASSIGNMENT IN EFFECT | |||
_________ | THERE IS NOT CURRENTLY A WAGE ASSIGNMENT IN EFFECT | |||
_______ | DO--Domestic Relations | _______ | D16--Foreign Judgment Other than Support | |
_______ | D01--Dissolution with Children | _______ | D17--URESA (from other jurisdiction) | |
_______ | D02--Dissolution without Children | _______ | D18--Out of County Judgment | |
_______ | D11--Legal Separation | _______ | D19--Establish Support | |
_______ | D12--Paternity/Maternity | _______ | D20--Habeas Corpus (custody) | |
_______ | D13--Annulment | _______ | D21--Visitation | |
_______ | D14--Custody | _______ | D30--Other Domestic Relations | |
_______ | D15--Order of Protection | _______ | D40--Emergency Order of Protection | |
Is the Issue: | ________________ | Custody and/or ________ ________Visitation? | |
Have you ever had an Order of Protection Y/N | ________________ | ||
When? _________________________ | Where? | ________________ |
L. R. Prac. Sup. Ct. 14 app A