Name:

____________________

[ ] Petitioner [ ] Respondent

ADDRESS PROTECTED

ARIZONA SUPERIOR COURT, COUNTY OF __________

____________________

Case No._________________________

Petitioner

ATLAS No._________________

____________________

REQUEST FOR PROTECTED ADDRESS

Respondent

I reasonably believe that physical or emotional harm may result to me or my minor child(ren) if my address is not protected from disclosure, and I request that the court order that my address be protected from public disclosure for the following reasons:

[ ] I have a valid Order of Protection against a party in this case issued by the following court (a copy is attached if available):

[ ] I have a valid Order of Protection against a party in this case issued by this court:

[ ] I have a valid Order of Protection against a person not involved in this case issued by the following court (a copy is attached if available):

[ ] I do not have a valid Order of Protection, but want my address protected for the following reasons:

My address is currently unknown to the other party. I have listed my address on a separate sheet of paper for court use.

I understand that I have a continuing duty to provide the clerk of the court with a current and correct mailing address where I can be served with process until one of the following events stated in Rule 7(f), Arizona Rules of Family Law Procedure, occurs.

_________________________

_________________________

Date

Requester’s Signature

PERSON WHOSE ADDRESS IS PROTECTED:

_________________________

[ ] Petitioner [ ] Respondent

ADDRESS TO BE PROTECTED:

Street:

_________________________

City:

_________________________

State, Zip Code:

_________________________

Telephone Number:

_________________________

ARIZONA SUPERIOR COURT, COUNTY OF __________

Case No.

Petitioner

ATLAS No.

ORDER FOR PROTECTED ADDRESS

Respondent

Upon Request of [ ] Petitioner [ ] Respondent, and good cause appearing,

IT IS ORDERED that:

The address of [ ] Petitioner [ ] Respondent shall be protected from public disclosure until further order of this court.

The Clerk of the Court shall protect the address of [ ] Petitioner [ ] Respondent from public disclosure until further order of this court.

The Clerk and the parties hereto shall comply with the requirements of Rule 7, Arizona Rules of Family Law Procedure, as follows:

Any person required under these rules to serve a response or other document upon a person whose address is ordered protected from disclosure under this rule may serve the same by delivering true and correct copies of the documents to be served, together with the proper fee established by administrative order to cover the cost of service, to the clerk of the court. The clerk shall promptly mail the documents by regular first-class mail to the most recent protected address provided to the clerk, and service shall be deemed complete upon mailing. The clerk shall promptly file a written statement verifying the documents that were mailed and the date of mailing to the protected address signed by the clerk or deputy clerk who mailed the documents. All documents mailed to a protected address shall bear the clerk’s return address, and a notation of any process returned as undelivered shall be made in the court file.

_________________________

Date

Judicial Officer