Free Data Sheet - Arizona

DATA SHEET Judicial Consent to Abortions for Minors Pursuant to A.R.S. § 36-2152(B)

Petitioner's true name: __________________________________________________ Fictitious name to be used (if any): _________________________________________ Name of attorney (if any): ________________________________________________ Attorney's address: _____________________________________________________ Attorney's phone number: ________________________________________________ Please indicate which of the following methods you wish to have the court use to contact you regarding this proceeding. In making your decision as to how you want to be contacted, please keep in mind that the court must keep this matter strictly confidential. ____ The court may telephone me at the following number: _______________ ____ The court may contact me by mail at the following address: Street Address: _________________________________________ City, State, and Zip Code: _________________________________ ____ The court may contact me at the following e-mail address: ____________________ ____ The court may contact me at the following fax number: ______________________ ____ I only want to be contacted personally and I am responsible for appearing in person at the office of the clerk of the superior court.

___________________ Date
03.03.03

_____________________________________ Signature of Petitioner (Please use true name)