Petition for Termination Of Parent-Child Relationship
The accurate completion of the form has to be ensured by the person filling this petition. The following file contains all the required information and guidance for successfully completing the form.
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Person Filing:
Address (if not protected):
City, State, Zip Code:
Telephone:
Email Address:
Lawyer’s Bar Number: Representing Self, without a Lawyer or Attorney for Petitioner OR Respondent
SUPERIOR COURT OF ARIZONA
IN MARICOPA COUNTY JUVENILE COURT
In the Matter of : Case No: JS
(To be completed by the Court)
PETITION FOR TERMINATION OF
PARENT -CHILD RELATIONSHIP
(SEVERANCE of PARENTAL RIGHTS)
A.R.S. § 8-531- 544
(Full Legal N ames of Minor Children)
1. INFORMATION ABOUT PETITIONER:
Name:
Birth Date:
Address:
Relationship to child ren:
2. INFORMATION ABOUT PARENT(S):
a. Mother’s name:
Mother’s birth date:
Mother’s address:
b. Father’s name:
Father’s birth date:
Father’s address:
(If more than one father involved, please attach same information for all fathers)
FOR CLERK’S USE ONLY
© Superior Court of Arizona in Maricopa County JS12f - 031616
ALL RIGHTS RESERVED Page 1 of 6
Case No. ____________________
3. INFORMATION ABOUT THE CHILDREN:
a. Child’s name: male female
Child’s birth date:
Child’s birth place:
Child’s address :
b. Child’s name: male female
Child’s birth date:
Child’s birth place:
Child’s address :
c. Child’s name: male female
Child’s birth date:
Child’s birth place:
Child’s address :
d. Child’s name: male female
Child’s birth date:
Child’s birth place:
Child’s address :
(If more than four children, please attach information for all children)
4. The person or agency currently having legal custody, guardianship, acting in loco parentis (acting as
parent) or providing care f or the children is:
Name:
Address :
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ALL RIGHTS RESERVED Page 2 of 6
Case No. ____________________
5.
6.
Will you or any person required to receive notice need a court interpreter? Yes No
If “Yes”, Person’s name: Language(s) needed
Perso n’s name: Language(s) need ed
Person’s name: Language(s ) needed
Jurisdiction in Arizona is proper because the child or children are present in Arizona Yes No
If the child or children are not present in Arizona, jurisdiction in Arizona is proper because:
7. Have t here been any prior court cases concerning the children? Yes No
If yes, list the name of the Court and the case number(s)
8. Is any parent or child an enrolled member of any native American tribe or nation ?
Yes No Uncertain
If “yes” or “uncertain”, please explain:
INSTRUCTIONS: Check all the allegations below that you believe apply. If seeking to
terminate the rights of more tha n one parent, attach a separate s heet for the additional
parents. If more space is needed for any answer, please attach additional information.
9.
The Court should terminate the parent-
child relationship between the children and the
Fa ther Mother based on the following grounds:
Abandonment : The parent has abandoned the children by failing to provide reasonable
support and failing to maintain regular contact with the children, including
normal supervision.
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ALL RIGHTS RESERVED Page 3 of 6
Case No. ____________________
Please state the facts supporting this statement:
Neglect/Abuse:
The parent has neglected or willfully abused a child.
Please state the facts supporting this statement:
Incapacity: The parent is unable to discharge the parental responsibilities because of
mental illness, mental deficiency or a history of chronic abuse of dangerous
drugs, controlled substances or alcohol and there are reasonable grounds to
b
elieve that the condition will continue for a prolonged, indeterminate
period.
Please state the facts supporting this statement:
Criminal
Conviction
The parent is deprived of civil liberties due to the conviction of a felony
the nature of which proves the unfitness of that parent to have future
custody and control of the children.
Please state the facts supporting this statement:
The parent is deprived of civil liberties due to the conviction of a felony
and the sentence of that parent is of such length that the children will be
deprived of a normal home for a period of years.
Please state the facts supporting this statement:
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ALL RIGHTS RESERVED Page 4 of 6
Case No. ____________________
Paternity
The potential father failed to file a paternity action within thirty (30) days
of completion of service of notice as prescribed by A.R.S. § 8 -106(G).
The putative father (one who registered with the state claiming to be the
father) failed to file a notice of claim of paternity as prescribed in A.R.S. §
8 -106.01.
Relinquishment
or Consent
The parent has relinquished his or her right to the children to an agenc y
or has consented to the adoption.
I have attached to this Petition a copy of all applicable relinquishment(s)
or consent(s).
Identity Unknown The identity of the parent is unknown and continues to be unknown
following three months of diligent efforts to identify and locate the
parent.
Please state the facts supporting this statement:
Other Parental rights should be terminated for other grounds under A.R.S. §
8 -533 as follows:
Please state th e facts supporting this statement:
10.
Best Interests
It is in the children’s best interest to have Father’s Mother’s
rights terminated.
Please state the facts supporting this statement:
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ALL RIGHTS RESERVED Page 5 of 6
Case No. ____________________
11.
Social Study
The social study discussed in A.R.S. § 8-
536(A) will be completed
by the following agency:
I request the social study discussed in A.R.S. § 8- 536(A) be waived
in the best interest of the children for the following reasons:
RELIEF REQUESTED: Based on the information above, after notice and a hearing Petitioner
requests the Court issue an order which:
Terminates the parent-child relationship between the children and their: Father M other, and
Appoints as guardian of the children and vests legal custody of the children in:
Orders that the parent(s) whose rights are terminated shall remain obligated for child
support payments until an adoption order is entered a nd shall remain obligated for
arrearages;
Orders that: (state any other relief requested);
and
Any other such orders as the Court deems just and proper.
I DECLARE UNDER PENALTY OF PERJURY THAT THE INFORMATION PROVIDED IN THIS
DOCUMENT IS TRUE AND CORRECT
Date Signature of Petitioner
Printed Name of Petitioner
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ALL RIGHTS RESERVED Page 6 of 6
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