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 __________

Petitioner

NOTICE OF LIMITED SCOPE

Respondent

REPRESENTATION

The undersigned attorney enters a Notice of Limited Appearance for [ ] Petitioner [ ] Respondent __________, pursuant to Rule 9(e).

1.

Counsel's appearance in this matter shall be limited in scope to the following matter(s): (Select all that are applicable, and provide detailed description of services, including any scheduled appearances, as needed.)

[ ]

Protective Orders

[ ]

Order of Protection

[ ]

Injunction Against Harassment

[ ]

Injunction Against Workplace Harassment

[ ]

Voluntary acknowledgment of paternity

[ ]

Establishment of Child Support (IV-D)

[ ]

[ ]

[ ]

[ ]

[ ]

Resolution Management Conference

[ ]

Arbitration

[ ]

Mediation

[ ]

[ ]

Settlement Conference

[ ]

[ ]

Enforcement of Decree or Order (specify, as follows):

[ ]

[ ]

[ ]

[ ]

[ ]

[ ]

Modification of Decree or Order (specify as follows):

[ ]

[ ]

[ ]

[ ]

[ ]

[ ]

[ ]

[ ]

[ ]

[ ]

[ ]

[ ]

[ ]

2.

Counsel named above is attorney of record and service of process on counsel shall be valid, to the extent permitted by statute and Rule 43(b) and (c), in all matters in the case but shall not extend the counsel's responsibility for representation of the client beyond the specific matter for which the attorney has appeared. For service directly upon the party, the party's name, address and phone number are listed below.

Name:

Address:

City, State Zip Code:

Telephone:

3.

The opposing party, or his/her counsel [ ] may [ ] may not directly contact the party represented by the undersigned attorney regarding matters outside the scope of this limited representation without first consulting the undersigned attorney.

4.

Counsel's representation of client will terminate at the conclusion of the hearing noted above, if shown, or at the conclusion of the matter noted above, upon the filing of a Notice of Withdrawal of Attorney, pursuant to Rule 9(e)(4).

5.

This accurately sets forth the terms of the written agreement between counsel and the party for limited scope legal representation.

_________________________

Date

Attorney

I have read and approve of this notice.

_________________________

Date

Client

ORIGINAL of the foregoing filed with the Clerk of the Superior Court;

COPIES of the foregoing mailed/delivered this ___ day of __________, __________, to: