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Person Filing: ________________________________________________

Mailing Address: ______________________________________________

City, State, Zip Code: __________________________________________

Telephone Number: ____________________________________________

Atlas Number (if applicable) _____________________________________

Representing Self (No Attorney) OR Represented by Attorney

If Attorney, Bar Number: ________________________________________

SUPERIOR COURT OF ARIZONA MOHAVE COUNTY

_______________________________________ (Name of Petitioner/Plaintiff)

AND

_______________________________________

(Name of Respondent/Defendant)

Case Number: ________________________

MOTION: __________________________

_____________________________________

_____________________________________

(Title of Form)

COMES NOW ______________________________ in the above captioned case to request the Court to: (Name)

_________________________________________________________________________________________

_________________________________________________________________________________________

_________________________________________________________________________________________

_________________________________________________________________________________________

For the following reason(s):

_________________________________________________________________________________________

_________________________________________________________________________________________

_________________________________________________________________________________________

_________________________________________________________________________________________

_________________________________________________________________________________________

_________________________________________________________________________________________

_________________________________________________________________________________________

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For Clerk’s Use Only

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Case No._____________________________ _________________________________________________________________________________________ _________________________________________________________________________________________ _________________________________________________________________________________________ _________________________________________________________________________________________ _________________________________________________________________________________________ _________________________________________________________________________________________ _________________________________________________________________________________________ _________________________________________________________________________________________ _________________________________________________________________________________________ _________________________________________________________________________________________ I declare under penalty of perjury that the foregoing is true and correct.

Signature: ________________________________________ Date: _______________ Copy sent to:

____________________________________________ (other party)

____________________________________________ (address)

____________________________________________ (city, state, zip)

on: _________________________________________ (date)