Form DRDC10F is used to request tax exemption for a qualified organization under section 501(c)(3) of the Internal Revenue Code. This form must be filed annually with the Arizona Department of Revenue, Tax Division. To qualify for tax exemption, an organization must meet certain requirements as set by the Internal Revenue Service. Exemption from state and local taxes can provide significant savings for qualifying organizations. For more information on Form DRDC10F and the application process, please visit the Arizona Department of Revenue website.
| Question | Answer |
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| Form Name | Arizona Form Drdc10F |
| Form Length | 11 pages |
| Fillable? | No |
| Fillable fields | 0 |
| Avg. time to fill out | 2 min 45 sec |
| Other names | CONCILIATION, 90-DAY, 401K, YAVAPAI |
Name:
Mailing Address:
Daytime Telephone:
Representing Self, Without a Lawyer
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IN THE SUPERIOR COURT OF ARIZONA, YAVAPAI COUNTY |
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In re the marriage of |
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ATLAS # |
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PETITION FOR DISSOLUTION |
Petitioner |
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OF A |
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WITH MINOR CHILDREN |
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and Request for Order of Paternity |
Respondent |
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STATEMENTS TO THE COURT, UNDER OATH
1.INFORMATION ABOUT ME, THE PETITIONER
Name: |
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Occupation: |
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How long I, the Petitioner, have lived in Arizona: |
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mos. |
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The Petitioner is enlisted in the military, and |
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deployed for at least one day during the past 6 months. |
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2.INFORMATION ABOUT MY SPOUSE, THE RESPONDENT
Name: |
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Occupation: |
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How long my spouse, the Respondent, has lived in Arizona: |
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The Respondent is enlisted in the military, and |
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deployed for at least one day during the past 6 months. |
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3.INFORMATION ABOUT OUR MARRIAGE
Date of Marriage: |
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City and state or country where married: |
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We do not have a covenant marriage. |
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[ ] I have, and/or [ ] my spouse has, lived or been stationed while a member of the Armed Forces, in Arizona for at least 90 days before my spouse filed this action. (IF THIS STATEMENT IS
NOT TRUE, YOU CANNOT FILE FOR DIVORCE UNTIL IT BECOMES TRUE.)
Superior Court of Arizona in Yavapai County |
Page 1 of 11 |
DRDC10f |
JULy 2010 |
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INFORMATION ABOUT PROPERTY AND DEBTS: |
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5a. PROPERTY ACQUIRED DURING THE MARRIAGE: |
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My spouse and I did not acquire any community property during the marriage. |
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My spouse and I acquired community property during our marriage, and we should divide it |
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as follows: (List the property and the value of the property, and check the box to tell the Court |
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who you believe should get the property.) |
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DESCRIPTION OF PROPERTY/ |
HUSBAND |
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SELL & |
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VALUE OF PROPERTY: |
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SPLIT |
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Real estate address: |
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Real estate address: |
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Household furniture and appliances: |
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Household furnishings: |
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Superior Court of Arizona in Yavapai County |
Page 2 of 11 |
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DRDC10f |
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JULy 2010 |
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HUSBAND |
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SELL & |
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SPLIT |
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Other items: |
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Pension/retirement fund/profit sharing/ |
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stock plan/401K: |
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Motor vehicles: |
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Lien Holder |
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Lien Holder |
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5b. PROPERTY ACQUIRED BEFORE MARRIAGE (Separate Property):(check all boxes that apply)
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I do not have any property that I brought into the marriage. |
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My spouse does not have any property that he or she brought into the marriage. |
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I have property that I brought into the marriage. I want this property awarded to me as |
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described it below: |
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My spouse has property that he or she brought into the marriage. I want this property |
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awarded to my spouse as described below: |
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Superior Court of Arizona in Yavapai County |
Page 3 of 11 |
DRDC10f |
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JULy 2010 |
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Separate Property: (List the property and the value of the property, and check the box to tell the Court who should get the property.)
DESCRIPTION OF PROPERTY/ |
HUSBAND |
WIFE |
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VALUE OF PROPERTY: |
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6a. DEBTS INCURRED DURING THE MARRIAGE: |
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My spouse and I did not incur any community debts during the marriage. |
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We should divide the responsibility for the debts incurred during the marriage as follows: |
DESCRIPTION OF DEBT/ |
HUSBAND |
WIFE |
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AMOUNT OF DEBT: |
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6b. SEPARATE DEBTS: (check all boxes that apply) |
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My spouse and I do not have any debts that were incurred prior to the marriage, OR |
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I have separate debt that I incurred prior to the marriage that should be paid by me as |
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described below: |
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My spouse has separate debt that he or she or incurred prior to the marriage that should be |
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paid by my spouse as described below: |
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DESCRIPTION OF DEBT/ |
HUSBAND |
WIFE |
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AMOUNT OF DEBT: |
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7.TAX RETURNS:
After the Judge or Commissioner signs the Decree of Dissolution of Marriage (Divorce), we will pay federal and state taxes as follows:
[ ] For previous years (the years we were married, not including the year the Decree is signed), the parties will file joint federal and state income tax returns.
Superior Court of Arizona in Yavapai County |
Page 4 of 11 |
DRDC10f |
JULy 2010 |
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[ |
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For previous calendar years, both parties will pay and hold the other harmless from |
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half of all additional income taxes if any and other costs, and each will share equally |
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in any refunds. |
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For the calendar year (the year that the Decree is signed) and all future calendar |
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years, each party will file separate federal and state income tax returns. Each party |
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will give the other party all necessary documentation to do so. |
8.SPOUSAL MAINTENANCE (ALIMONY) (check the box that applies to you):
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Neither party is entitled to Spousal Maintenance (alimony), OR |
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Petitioner OR [ ] Respondent is entitled to Spousal Maintenance because: (Check one or |
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more of the box(es) below that apply. At least one reason must apply to get spousal |
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maintenance.) |
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Person lacks sufficient property to provide for his or her reasonable needs; |
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Person is unable to support himself or herself through appropriate employment; |
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Person is the custodian of a child(ren) whose age or condition is such that the person |
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should not be required to seek employment outside the home; |
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Person lacks earning ability in the labor market adequate to support himself or |
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herself; |
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Person contributed to the educational opportunities of the other spouse or had a |
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marriage of long duration and is now of an age that precludes the possibility of |
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gaining employment adequate to support himself or herself. AND |
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Spousal maintenance shall be modifiable in accordance with Arizona law, OR |
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The parties acknowledge that the circumstances of their futures are unknown, but each |
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desires that this maintenance award not be modifiable in the future for any reason. |
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Therefore, it is ordered at this time that this spousal maintenance award shall not be |
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modifiable for any reason. |
9.CHILD(REN) OF THE PARTIES WHO ARE LESS THAN 18 YEARS OLD:
The following child(ren) are under age 18 and were born during the marriage or adopted by me and my spouse: (attach extra pages if necessary)
Child’s Name:
Birth date:
Address:
Length of time at address:
Names and addresses of persons lived with for the past five (5) years:
Present addresses of person(s) lived with:
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The [ ] Petitioner |
OR [ ] Respondent is not the biological or adoptive |
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parent. |
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Superior Court of Arizona in Yavapai County |
Page 5 of 11 |
DRDC10f |
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JULy 2010 |
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Child’s Name:
Birth date:
Address:
Length of time at address:
Names and addresses of persons lived with for the past five (5) years:
Present addresses of person(s) lived with:
[ ] The [ ] Petitioner OR [ ] Respondent is not the biological or adoptive parent
Child’s Name:
Birth date:
Address:
Length of time at address:
Names and addresses of persons lived with for the past five (5) years:
Present addresses of person(s) lived with:
[ ] The [ ] Petitioner OR [ ] Respondent is not the biological or adoptive parent.
Child’s Name:
Birth date:
Address :
Length of time at address:
Names and addresses of persons lived with for the past five (5) years:
Present addresses of person(s) lived with:
[ ] The [ ] Petitioner OR [ ] Respondent is not the biological or adoptive parent.
The following child(ren) are under age 18 and were born prior to the marriage and are common to me and my spouse: (attach extra pages if necessary)
Child’s Name:
Birth date:
Superior Court of Arizona in Yavapai County |
Page 6 of 11 |
DRDC10f |
JULy 2010 |
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Address:
Length of time at address:
Names and addresses of persons lived with for the past five (5) years:
Present addresses of person(s) lived with:
10. CUSTODY OR PARENTING TIME CASES INVOLVING THE MINOR CHILD(REN):
[ ] I HAVE [ ] I HAVE NOT been a party or a witness in court, in this state or any other state, involving the custody or parenting time of any child(ren) named above. (If so, explain below, using extra pages if necessary.)
Name of child:
Court state: |
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Court location: |
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Court case number: |
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Status : |
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How the child is involved: |
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Summary of any court order: |
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11.PENDING/PAST CASES RELATED TO MINOR CHILD(REN): (check one box)
[ ] I DO [ ] I DO NOT know of any court case, in this state or any other state, that could affect this case, including enforcement, domestic violence, protective orders, drugs, sexual offenses, termination of parental rights and adoptions. (If so, explain below, using extra pages if necessary.
Court state: |
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Court location: |
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Court case number: |
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Status: |
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Nature of the proceeding: |
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Date of conviction: |
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12.CUSTODY OR PARENTING TIME CLAIMS OF ANY OTHER PERSON: (Check one box)
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I KNOW |
[ ] I DO NOT KNOW the name and address of any person, other than the Petitioner |
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or the Respondent, who has physical custody of the child(ren) or claims rights of legal custody, |
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physical custody or parenting time of any child(ren) named above. (If so, explain below, using extra |
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pages if necessary.) |
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Name of each child: |
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Name of person with the claim: |
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Address of person with the claim: |
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Nature of the claim: |
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PREGNANCY AND PATERNITY: |
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Wife is not pregnant, OR |
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Wife is pregnant: Due date |
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AND, |
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The Petitioner and Respondent are the parents of the child, OR |
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Petitioner is not the parent of the child, |
OR |
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Superior Court of Arizona in Yavapai County |
Page 7 of 11 |
DRDC10f |
JULy 2010 |
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Respondent is not the parent of the child. |
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A child or children was/were born before the marriage. The husband is |
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the father of that child/those children named below: |
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14.WRITTEN AGREEMENTS, CHECK ONLY IF TRUE:
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For our child(ren), my spouse and I have a written agreement signed by both of us about: |
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Custody; |
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Parenting time; |
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Child support. |
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My spouse and I have a written agreement not related to the child(ren) and signed by both of |
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us about |
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I am filing the ORIGINAL Agreement. |
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15. |
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The Attorney General's office is involved in this case (TANF, |
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OTHER STATEMENTS TO THE COURT UNDER OATH: You must tell the Court the truth. Lying to the Court is a crime and the Court can punish you for lying. To file for divorce, you must be able to tell the Court that the following statements are true. If the statements are not true, you cannot file for divorce until the statements are true. Check the box in front of each statement if the statement is true.
STATUS OF MARRIAGE AND CONCILIATION:
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TRUE: My marriage is irretrievably broken and there is no reasonable prospect of |
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reconciliation. (My marriage is over.) |
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TRUE: The conciliation requirements under Arizona law, A.R.S. |
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do not apply or have been met. |
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TRUE: This Court has jurisdiction to decide child custody matters under Arizona |
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law. |
REQUESTS TO THE COURT:
1.DISSOLUTION (DIVORCE):
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Dissolve the parties' marriage and return each party to the status of a single |
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person; |
2.NAMES:
Restore [ ] wife [ ] husband to her or his former name of
WARNING: If you are not the person who is requesting to have your former name restored, the Court must have a written request from the party who wants his or her name restored to change the name.
3.SPOUSAL MAINTENANCE (ALIMONY):
[ ] Neither party shall pay spousal maintenance (alimony) to the other party, OR
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] Petitioner OR [ ] Respondent is ordered to pay the other party the sum of |
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$ |
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per month spousal maintenance BEGINNING |
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AFTER THE Decree is signed. Each payment shall be made by the first day of each |
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Superior Court of Arizona in Yavapai County |
Page 8 of 11 |
DRDC10f |
JULy 2010 |
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month thereafter and shall continue until [ ] the receiving party is remarried or deceased OR
[ ] until (date). All payments shall be made through the Clerk of the
Court by automatic wage assignment until all required payments have been made under the Decree. Payments made shall be included in receiving spouse's taxable income and are tax deductible from the paying spouse's income as required by law.
[ ] In accordance with the parties' agreements,
[ ] The spousal maintenance award shall be modifiable in accordance with Arizona law, OR
[ ] The spousal maintenance award shall NOT be modifiable for any reason.
4.COMMUNITY PROPERTY:
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Make a fair division of all community property as requested in this Petition. |
5.COMMUNITY DEBTS:
[ ] Order each party to pay community debts as requested in the Petition, and to pay any other community debts unknown to the other party. Order each party to pay and hold the other party harmless from debts incurred by him or her since the parties separation
on |
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6.SEPARATE PROPERTY:
[ ] Award each party his or her separate property.
7.PATERNITY: Declare the husband to be the father of the following named child(ren) born before the marriage and (optional) change the legal name of those children to the name listed below:
Current legal name |
Change legal name to: |
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8.AWARD CHILD CUSTODY AND PARENTING TIME as follows:
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SOLE CUSTODY: Sole custody of the minor child(ren) awarded to [ ] Petitioner or |
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Respondent subject to parenting time for the noncustodial parent as follows: |
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Reasonable parenting time pursuant to the Yavapai County Child Access |
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Guidelines; |
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2. |
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Reasonable parenting time pursuant to the attached Parenting Plan; |
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Supervised parenting time. Supervised parenting time is in the best |
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interest(s) of the child(ren) because unrestricted parenting time would |
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seriously endanger the child(ren)'s physical, mental, moral or emotional |
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health. These facts support my claim: |
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Name of person who will supervise: |
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The cost of supervised parenting time shall be paid by [ ] Petitioner |
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OR |
[ ] Respondent |
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[ ] shared equally. |
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No parenting time: (check and explain ONLY if you want the other party |
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to have no parenting time): No parenting time between the child(ren) and |
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the other party is in the best interests of the child(ren) because any parenting |
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time would seriously endanger the child(ren)'s physical, mental, moral or emotional health.
These facts support my claim:
Superior Court of Arizona in Yavapai County |
Page 9 of 11 |
DRDC10f |
JULy 2010 |
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OR
[ ] JOINT CUSTODY: Petitioner and Respondent agree to act as joint custodians of the minor child(ren) as set forth in the Joint Custody Agreement. (A Joint Custody Agreement
signed by both parents must be attached) |
AND |
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Domestic violence has not occurred during this relationship; |
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OR |
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Domestic violence has not been significant. However, domestic violence has |
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occurred as described in the Petition for Order of Protection(s) filed or as described below:
OR
[ ] Joint custody is in the best interest of the child(ren) even though domestic violence has occurred because:
Furthermore, the [ ] Petitioner AND/OR [ ] Respondent has/have taken classes, participated in counseling or taken steps to avoid further domestic violence as described below:
9.CHILD SUPPORT: Support payments will begin on the first day of the first month following the entry of the Dissolution Decree. These payments, and a fee for handling, will be paid through the Clerk of the Court/Clearinghouse and collected by automatic wage assignment.
[ |
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Order that child support shall be paid by [ ] Petitioner OR [ ] Respondent in a |
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reasonable amount as determined by the Court under the Arizona Child Support |
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Guidelines and according to the Parent’s Worksheet, which shall be filed with this |
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Petition. |
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OR |
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Order that child support be paid in an amount that deviates from the Guidelines |
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because: |
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Application of the Guidelines is inappropriate or unjust because: |
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The parties have signed a written agreement free of duress and coercion with |
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knowledge of the amount of support that would have been ordered by the |
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Guidelines but for the agreement. A copy of the agreement is attached. |
10.HEALTH, MEDICAL, DENTAL INSURANCE AND HEALTH CARE EXPENSES FOR CHILD(REN): Order that [ ] Petitioner or [ ] Respondent shall pay for health, medical, dental insurance coverage
for the child(ren) under the age of 18 years, and that [ ] Petitioner or [ ] Respondent shall pay for all reasonable unreimbursed medical, dental,
Superior Court of Arizona in Yavapai County |
Page 10 of 11 |
DRDC10f |
JULy 2010 |
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11.TAX EXEMPTION: The parties will claim the child(ren) as income tax dependency exemptions on
federal and state income tax returns and as allowed by federal and state tax laws as follows:
Parent entitled to claim |
Name of child |
Current tax year Later tax years |
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] Mother |
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] Father |
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] Mother |
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] Father |
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] Mother |
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] Father |
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] Mother |
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] Father |
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12.OTHER ORDERS I AM REQUESTING (Explain request here):
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OATH AND VERIFICATION |
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STATE OF |
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County of |
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I, the Petitioner, being duly sworn and under oath, state that I have read this Petition. All the statements in the Petition are true, correct, and complete to the best of my knowledge and belief.
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Signature |
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SUBSCRIBED AND SWORN to before me this |
day of |
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, by |
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My Commission Expires: |
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NOTARY PUBLIC |
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Superior Court of Arizona in Yavapai County |
Page 11 of 11 |
DRDC10f |
JULy 2010 |
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