Form 3. Confidential Sensitive Data Form

Name: Mailing Address: City, State, Zip Code: Daytime Phone Number: Evening Phone Number: Representing: [ ] Self [ ] Petitioner [ ] Respondent State Bar Number: ARIZONA SUPERIOR COURT, COUNTY OF __________ Case No. Petitioner ATLAS No. CONFIDENTIAL SENSITIVE DATA FORM Respondent A. Personal Information: Name Date of Birth Social Security Number Petitioner: Respondent: Child: Child: Child: Child: B. Financial account numbers (including credit cards, financial institution accounts, investments, debts): Financial Institution Type of Account Name(s) on Account Account # C. Pension and retirement accounts (including IRAs, 401(k)s): Financial Institution Type of Account Name(s) on Account Account # D. Life insurance policies: Insurance Company Type of Policy Name(s) on Policy Policy #