Category: Uncategorized

zarifi_lawsuits

Download PDF

margaret_floyd_vs_larry_tamburro

. Elliot Grysen . RYSEN & ASSOCIATES 06 River Street grin Lake, MI 49456 16 7~2121 616 847—6208 Sfacsimile) tate Bar No. 0 1871 ounsel for Plaintiff

aren Tobler Hanson OBLER 8: ASSOCIATES ‘

201 S. Alma School Road, Suite 8550 esa, Arizona 85210

tate Bar No. 021361

o—Counsel for Plaintiff

IN THE SUPERIOR COURT OF THE STATE OF ARIZONA IN AND FOR THE COUNTY OF MARICOPA

ARGARET FLOYD, individually and n begialf ($3111 E’fitfiolr IljézJIlIelfJiciaries of ece ent . ’ ’ CV 2 0 0 9 – ’ Plaintiff, D I 0 0

No. CV—2009~

g/Iort, Non-Motor Vehicle; ARRY S. TAMBURRO, MD. 8: ‘ edical Negligence) ANE DOE TAMBURRO, Husband & Wife; AST VALLEY FAMILY PHYSICIANS, PLC; AI-IMOOD SHAHLAPOUR, MD. & AN E DOE SHAHLAPOUR, Husband & Wife SSOCIATED INTERNISTS OF WATUKEE, P.C.;

nd JOHN AND ANE DOES I-V; i COMPLAINT nd BLACK AN WHITE CORPS.I—V; ,-.

nd GREY PARTNERSHIPS I-V, Defendants.

25 26 27 28

Plaintiff, for hef cause of actionagainst the above named and fictitiously designated

efendants, alleges as follows:\OOOQChw-bwtx)

1.

Margaret Floyd, individually and on behalf of the statutory beneficiaries of ecedent, William Floyd (“Plaintiff”) is a resident of Phoenix, Arizona. Defendants Larry . Tamburro, MD. and Jane Doe Tamburro, Husband and Wife, (“Defendants Tamburro”); ast Valley Family Physicians, P.L.C. (l’Defendant East Valley”); Defendants Mahmood R. hahlapour and Jane Doe Shahlapour (“Defendants Shahlapour”); and Associated nternists of Ahwatukee, RC. (“Defendant Associated Internists”) all practice or provide

edical care and services in the State of Arizona in the County of Maricopa, and on

nformation and belief Defendants are residents of Maricopa County, Arizona. Plaintiff

rings this action pursuant to the Arizona Medical Malpractice Act, A.R.S. 12-561 et. seq. II.

The events which are subject to this litigation occurred in Maricopa County, rizona.

III.

The true names of John and Jane Does I-V, Black and White Corporations I-V, and rey Partnerships I-V are presently unknown to Plaintiff and, therefore, they are esignated by use of fictitious names and capacities. Plaintiff is informed and believes and herefore alleges that each Defendant so designated may be legally responsible in some

anner for the events referred to herein and proximately caused damage to Plaintiff. If Iaintiff at a later time discover the identities of these fictitiously named parties, Plaintiff ill at that time seek leave of the Court to amend this Complaint and name the presently ‘ctitiously-named Defendants and more fully describe their conduct which has contributed

o damages sustained by Plaintiff.

IV. That each of the individually named Defendants were at all times acting for the

enefit of their marital community.V.

At all times pertinent hereto, each of the individually named Defendants acted as

he agent, ostensible agent, and / or servant of every other named Defendant.

VI.

At all times mentioned herein, Defendant Tamburro was functioning as a physician icensed to practice medicine within the State of Arizona and held himself out to Decedent,

illiam Floyd and to the public as qualified and skilled in family medicine and licensed

KOOOKJCth-bmw

nder the laws of the State of Arizona. And, at all times pertinent hereto and for years 10 11 12 13 l4 15 16 17 1 8 19 20 21 22

ast, Defendant Tamburro engaged in the practice of family medicine where persons equiring care and treatment are given such for a consideration. And, at all times pertinent ereto, Defendant Tamburro represented and held himself out to the public, and in articular Decedent Floyd, as a qualified physician educated and prepared to receive the ublic, and in particular Decedent Floyd for his general and family practice care, diagnosis, nd treatment.

VII.

At all times mentioned herein, Defendant Shahlapour was functioning as a hysician licensed to practice medicine within the State of Arizona and held himself out o Decedent, William Floyd and to the public as qualified and skilled in internal medicine nd licensed under the laws of the State of Arizona. And, at all times pertinent hereto and

or years past, Defendant Shahlapourj engaged in the practice of internal medicine where

23 ersons requiring such care and treatment are given such for a consideration. And, at all 24 “mes pertinent hereto, Defendant Shahlapour represented and held himself out to the 25 ublic, and in particular Decedent Floyd, as a qualified physician educated and prepared

26 27 28

0 receive the public, and in particular Decedent Floyd for his internal medicine care,

iagnosis, and treatment.VIII.

Jane Doe Tamburro and Jane Doe Shahlapour , upon information and belief, are the pouses of Defendants Tamburro and Shahlapour, and are named as a party herein because hey benefitted financially from the professional earnings of their spouse, whereby the

ommunity property of such husband and wife were augmented.

IX.

At all times mentioned herein, Defendant East Valley is an Arizona corporation

\OOO‘JO‘M-bww

hich provides medical and family care and services in Maricopa County, Arizona, or the 10 I l 1 ‘ 12 13 14 15 16 17 18 19 ‘ 20 21 22 23 24

urrounding area, and employs, controls, or otherwise is related to Defendant Tamburro,

At all times mentioned herein, Defendant Associated Internists is an Arizona orporation which provides internal medicine physicians, nurses, and medical staff in

aricopa County, Arizona, or the surrounding area, and employs, controls, or otherwise

XI. All Defendants named herein, either individually, or by and through their duly

uthorized agents, servants, and / or employees, had the duty to provide to Decedent Floyd

25 ith competent and qualified medical care, and to properly diagnose, treat, render 26 ompetent advice and assistance, monitor, test, and render the same in accordance with the 27 edical standards of care. Plaintiff relied upon Defendants covenant to so render 28 ompetent care. All named Defendants breached this duty.

4KOOO‘JONLII-b-UJN

10 11 12 13 14 1s 16 17 18 19 20 21 22 23 24 25 26 27 28

XII. This matter exceeds the jurisdictional limit of this Court and Plaintiff will at the

ppropriate time, and in the proper form, request a trial by jury of all applicable issues.

XIII.

Beginning with care received back as early as 2004 and a diagnosis of colon cancer

‘n 2008, for a consideration which Plaintiff would pay and was required to pay, these efendants undertook to furnish medical and nursing care, attention, counsel, diagnosis, esting, screening, management, treatment, and supervision for Decedent Floyd. Plaintiff elied upon these Defendants as specialists in their designated field, and as such the elationship of patient and physician and/ or patient and nurse, and/ or patient and edical staff was thereby created, all within the setting of Defendants East Valley and ssociated Internists and under the direct supervision of Defendants Tamburro and

hahlapour.

XIV.

Beginning as early as 2004, for a fee paid, Defendants recommended, managed, iagnosed, tested, interpreted, and provided medical care and treatment to Decedent Floyd

ith substantial financial reward to these Defendants. Plaintiff was never informed that this medical diagnosis, management, testing, nterpretation, care and treatment by: these Defendants could result in the complications nd death of William Floyd. These Defendants negligence has caused the death of William loyd and has caused Plaintiff to suffer economic damages as well as non-economic

amages including pain, suffering, psychological, and hedonic damages.\DOOKJmUl-D-UJN

10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26

27 28

‘ XV.

These Defendants took on the care and treatment William Floyd and were thereby esponsible to work up, advise, counsel, obtain informed consent, evaluate, monitor, iagnose, test, and properly treat Decedent Floyd for his symptoms and medical

onditions. The advice, counsel, obtaining of informed consent, evaluation, monitor, iagnosis, testing, care and treatment of these Defendants fell below the applicable tandard of care, and that as a direct and proximate result of these respective Defendants,

‘ ach and every one, falling below the applicable standard of care, Decedent Floyd suffered

a nd died under their care.

XVI.

As a further direct and proximate result of the negligence of Defendants actions both ndividually and jointly, the Plaintiff has suffered monetary damages including special – amages and costs directly associated ‘with the death of Decedent Floyd. Special damages Include all additional medical expenses incurred by the Plaintiff as a result of Defendants’

I egligent diagnosis, care and treatment.

XVII. The actions as described above, constitute negligence in failing to provide proper ounseling, testing, monitoring, work up, evaluation, diagnosis, nursing, and treatment by

hese Defendants, which would have resulted in cement by Decedent Floyd.

XVIII. As a result of the Defendants actions, Plaintiff is entitled to an award of ordinary

a nd special damages in this action based upon Defendants lack of informed consent.l 2 3 4 5 6 7 8 9

10 11 12 13 14 15 16 17 18 i9 20 21 22 23 24 25 26 27 28

xxx. ‘

At the time of the events set forth above, these Defendants pursued a medical iagnosis, care and treatment which resulted in conduct that was outrageous, negligent, eprehensible and in conscious disregard for Decedent Floyd’s safety and welfare, causing- ’ suffering and eventual death under their care. Defendants’ course of conduct was so nreasonable and merely for the financial benefit of each and every Defendant, and such ourse of conduct was so malicious, wilful, wanton, reckless and / or grossly negligent as o warrant the imposition of punitive damages to punish Defendants and to deter such ehavior in the future. These Defendants behavior, each and every one, included

onsciously placing Decadent Floyd’s health at substantial risk of harm resulting in his

eath.

WHEREFORE, Plaintiff prays for the following judgment or relief against

efendants, jointly, separately and their marital communities, as follows:

1. For an award of general damages in an amount sufficient to fairly compensate Plaintiff, in, an amount not presently ascertained, but in excess of the jurisdiction amount of this Court, consistent with proof in this action;

2. For the reasonable value of special damages including medical expenses incurred to date and to be incurred in the future, in an amount not presently ascertained, but in excess of the jurisdictional limits of this Court, consistent with the proof in this action, together with prejudgment interest thereon;

3. For an award of punitive damages in an amount to be proved at trial herein under the respective legal theories outlined above;

4. For Plaintiff’s costs incurred as a result of Defendants negligent and

imprudent care and treatment, together with prejudgment interest thereon;For Plaintiff’s costs incurred as a result of the injuries; For Plaintiff’s taxable costs in bringing this action;

For such additional damages as this Court deems a – ropriate;

9°39.“

a» ems appropriate.

For such other and further relief WhiC o

A.

. I A 13.13 iot sen / Counself Pla’ A;

806 River Street Spring Lake, chigan 49456

ated thisgday of March , 2009.

:\Documents and Settings\gloria\Local Settings\Temp\complaint.wpd

barbara_stidham_vs_thomas_hopkins

‘ MICHAEL K. JEANES Clerk of the Superior Court BY Helissa fatten, fiamty Date WW2013 Time 14:15:54

mediation fittflmt ‘E-i”‘“ CREE? MOE-G93??? fine”— Michael L. York, #015362 {Riflwfi’Lm Brian M. Torba, #028295 – mm – 1 WATTEL & YORK 30am 2 2175 North Alma School Road, #BlO? Chandler, Arizona 85224 3 (480) 222-2020; Fax (480) 899-2741 Email: [email protected] 4 Allorlieysfor Plaintiff 5 IN THE SUPERIOR COURT OF THE STATE OF ARIZONA 6 IN AND FOR THE COUNTY OF MARICOPA‘

7 BARBARA STtDHUM, No

‘cv2013-092799

COMPLAINT

8 _ Plaintiff, 9 VS.

10 LAURENEASHLEY HOPKINS, a Minor, by and through her next friend, SUSAN

H HOPKINS; LAUREN ASHLEY HOPKINS, individually; SUSAN HOPKINS and

12 THOMAS HOPKINS, husband and wife; DOES l—XX and BLACK & WHITE

13 CORPORATIONS I—V,

Tort/ Motor Vehicle

2l75 Nonh Alma School Rood, Suite B-lO7

Wonel & York

14 Defendants.

VVVVVVVVVVVVVVVV

15′ Plaintiff alleges as follows:

16 I.

17 . . . . . The events giving rise to the cause of action set forth herein occurred Within the County of

18 . . . . . . . . . Maricopa, State of Arizona, that this Court has Jurisdiction over the sub] ect matter and the parties

19 . . . . to this litigation.

20 I].

A T T O R N E Y S A T L A W Chandler, Arizona 85224

WATTEL&YORK

21 Thai Defendant, LAUREN ASHLEY HOPKINS, upon information and belief, at all times

22 , relevant hereto, was a minor.

23 Ill.

24 That Defendants, SUSAN HOPKINS and THOMAS HOPKINS, upon information and

25 belifif, was at all times relevant hereto married and was acting on behalf of and for the benefit of said

26217 5 North Alma School Road, Suite B~l07

Wottei & York

A T T O R N E Y S A T L A W Chandler, Arizona 85224

WATTEL&YORK

10 ll T2 13 14 15 16 17 18 19 20 21 22 23

24

25

26

Defendants’ marital community. IV.

That Defendants, SUSAN HOPKINS and THOMAS HOPKLNS, upon information and belief, are the parents of the minor, LAUREN ASHLEY HOPKINS, and thus are responsible for her actions.

V.

The “Doe” Defendants l-XX are each fictitious names to designate unknown parties who may have in some manner contributed to Plaintiff’s injuries and damages and are liable therefore. The true names for said Defendants are unknown to the Plaintiff at this time and leave of Court is sought to amend this Complaint to include their true names after they are discovered.

VI.

The “BLACK & WHITE CORPORATIONS” Defendants l—V are each fictitious names to designate unknown companies and/or corporations and/or partnerships who may have in some manner contributed to Plaintiff’s injuries and damages and are liable therefore. The true names for said Defendants are unknovm to the Plaintiff at this time and leave of Court is sought to amend this Cemplaint to include their true names after they are discovered.

VII.

That on or about May 29, 2012 at or near south Priest Drive and West Grove Parkway in Tempe, Arizona, Defendant, LAUREN ASHLEY HOPKINS, operated and/or maintained a vehicle in a negligent manner and with reckless disregard of the rights and feelings of the Plaintiff, thereby causing damage to the Plaintiff.

VIII. Defendants, SUSAN HOPKINS and THOMAS HOPKINS, negligently entrusted a vehicle

to their minor child.

IX. Upon information and belief, Defendants SUSAN HOPKINS and THOMAS HOPKINS,2175 North Almc: School Road, Suite 8-107

Wottel & York

A T T O R N E Y S A T L A W Chondler,Arizono 85224

WATTEL&YORK

provided the vehicle involved in the subject coliision for general use by members of the family

including Defendant LAUREN ASHLEY HOPKINS. Therefore, Defendants SUSAN HOPKINS and

2 . . THOMAS HOPKINS are vicariously liable for any harm that is caused by or related to the use of 3 . . . the vehicle under the F amily Purpose Doctrine. 4 X. 5 . That as a result of Defendants conduct as stated ab0ve, Plaintiff, BARBARA STEDHUM, 6 sustained permanent personal injuries, which have caused pain, suffering and inconvenience; has 7 incurred expenses for medical care which will continue; and has suffered a loss of earnings, which 8 will continue. Plaintiff asks leave to amend as necessary to conform to the proof regarding the exact 9 amount of said past and future losses. 10 XI. 11 . . . . . . . . . Damages herein exceed the minimum Jurisdictional limits of the Court. 12 XII. 1 3 That Defendant, LAUREN ASHLEY HOPKINS, may now be an adult and therefore subject M to suit individually. 1 5

WHEREFORE, Plaintiff, BARBARA STIDHUM, prays for judgment against the

16 Defendants, as follows:

17 1. For such sums as and for general damages as may be fair and just.

1 8 2. For those special damages incurred to date, plus those future special damages proved at

19 . ~ the time of trial.

20 3. For costs of suit herein; and,

21 4. For such other and further relief as the Court deems just and proper.

22 . . DATED this id day ofMarch, 201

23 24 25

26

thomas_hopkins_vs_susan_hopkins

‘ 1 MICHAEL K. We Clerk of the Superior Court

Name of Person Filing: Thomas Garrett Hopkins . – . In this case I am: petitioner [3 Respondent BY Sl’iEfla mush. Dearly

in this case I am: El Representing Myself (No Attorneyfisgiw? 93/ 1412614 T159 1455313‘

If Represented by Attorney: Attorney Bar Number: #:1331011 mm My Address: (if not protected) 4035 E. Summeri’iaweor;r4 f“ D N 3935“ me‘oonafi

City. State, Zip Code: Phoenix Arizona 85

Telephone Numbers: i480) 404-6489 _ m muff 338“

SUPERIOR COURT OF ARIZONA IN MARieditAitiggbfiigg33.3%,l2 3“”

FN2014—001i86

THOMAS GARRETT HOPKINS Case Number: Petitioner ATLAS Number: (if‘ applicable) SUSAN D. HOPKINS PETITION FOR DISSOLUTION OF A Respondent NON—COVENANT MARRIAGE (DIVORCE) WITHOUT CHILDREN

STATEMENTS TO THE COURT, UNDER OATH OR AFFIRMATION:

1. INFORMATION ABOUT ME, THE PETITIONER:

Name: Thomas Garrett Hopkins Address: 4035 E. Summerhaven Phoenix AZ 85044

Date of Birth: November 28 1961

Job Title: Physician ‘ _ _____z_________——— I have lived in Arizona for 27 years and 1 month

2. INFORMATION ABOUT THE RESPONDENT:

Name: Susan D. Hopkins Address: 4102 E. Goldfinch Gate Lane, Phoenix, AZ 85044 ’

Date of Birth: January 28I 1959 .__ _______ _ ._ .__ Job Title: Clinical Pharmacist

Respondent has lived in Arizona for 31 years andfor _ months

3. INFORMATION ABOUT, MY THE MARRIAGE:

Date of Marriage: May 16, 1987 City and state, or country where we were married: Rancho Santa Fe CA

The following statements MUST BE TRUE for you to use this document and to qualify for divorce in Arizona AND you must check the boxes to indicate that the statements are true or your case may not proceed. We do not have a covenant marriage (if not sure, refer to the INSTRUCTIONS for information).

Our marriage is broken beyond repair (“irretrievably broken”) and there is no hope of reconciliation.

We have tried to resolve our problems through Conciliation Services or going to Conciliation Services would not work. ‘

4. 90 DAY REQUIREMENT: (This statement MUST be true before you can file for divorce in Arizona). IX“ OR B my spouse have lived, in Arizona or have been stationed in Arizona while a member of the Armed Forces, for at least 90 days before I filed this action

OSuperior Court of Arizona in Mal-ice c my .- ALL RIGHTS RESERVED pa w page 1 of 6 ‘QQ‘RDCfif 011013 a

COM 4 ~7.a.

Case Number:

DOMESTIC VIOLENCE: (if you intend to ask for joint legal decision making authority coin: custody), there must have been no significant domestic violence in your marriage. ARS. 25403.03. Check the box to make a true statement): w , ,

Significant domestic violence [:1 has OR 12 has not occurred during this marriage.

PREGNANCY: (Check one box)

EX] Wife is not pregnant,

COMMUNITY PROPERTY. (Check one box) – D My spouse and I did not acquire any community property during the marriage, OR >14 My spouse and I acquired community property during the marriage, and we should divide it as follows: – Petitioner Respondent Value

[I Real Estate located . El [:1 $___.__

The parties agree to address division of property in accordance with the Comprehensive Mediated Settlement Agreement, to be signed and attached to the Decree of Dissolution of Marriage.

E] Household furniture and appliances: Petitioner Respondent Value El El 5_ El III $___

The parties agree to address division of property in accordance with the Comprehensive Mediated Settlement Agreement, to be signed and attached to the Decree of Dissolution of Marriage.

[3 Household furnishings: Petitioner Respondent Value El El $___ D E] $__ El Cl $___

The parties agree to address division of property in accordance with the Comprehensive Mediated Settiement Agreement, to be signed and attached to the Decree of Dissolution of Marriage.

[3 Other items: Petitioner Respondent Value ‘ E] El $___ El Cl $____ El Cl $_____

The parties agree to address division of property in accordance with the Comprehensive Mediated Settlement Agreement, to be signed and attached to the Decree of Dissolution of Marriage.

El Pensionlretirement fundlprofit sharinglstock planl401 K:

Petitioner Respondent Value El El $___ El El 3

Page 2 of 67.b.

8.a.

Case Number:

El D $___

The parties agree to address division of property in accordance with the comprehensive Mediated Settlement Agreement, to be signed and attached to the Decree of Dissolution of Marriage.

D Motor vehicles: Petitioner Respondent Value Make: Year: I] E] 3 Model: I] [:1 VIN: Lien Holder:

The parties agree to address division vehicles in accordance with the Comprehensive Mediated Settlement Agreement, to be signed and attached to the Decree of Dissolution of Marriage.

SEPARATE PROPERTY: (Check all hexes that apply.)

I do not have any property that I brought into the marriage or separate property.

My spouse, the Respondent does not have any property that he or she brought into the marriage or separate property.

l have property that brought into the marriage or I have separate property. I want this property awarded to me as described below.

My spouse, the Respondent, has property that he or she brought into the marriage or has separate property. I want this property awarded to my spouse as described below.

DUDE

Separate Property: (On the next page, list the property and the value of the property, and check the box to tell the court who should get the property.)

Description of Separate Property Petitioner Respondent Value El El $__ El El $___

The parties agree to address division of property in accordance with the Comprehensive Mediated Settlement Agreement, to be signed and attached to the Decree Dissolution of Marriage.

COMMUNITY DEBTS: (check one box)

I] My spouse and I did not incur community debts during the marriage, OR C] We should divide the responsibility for the debts incurred during the marriage as follows:

DESCRIPTION OF DEBT Petitioner Respondent Amount Owed El E] $_____ El El $___._ El El $

8.b. SEPARATE DEBTS: (check all boxes that apply.)

E] My spouse and I do not have any debts that were incurred prior to the marriage or separate debt;

[:I l have separate debt or debt that l incurred prior to the marriage which should be paid by me as described below;

D My spouse has separate debt or debt that he or she incurred prior to the marriage that

Page 3 of 6Case Number:

should be paid by my spouse as described below.

DESCRIPTION OF DEBT

Petitioner Respondent Amount Owed

El El $ 7

The parties agree to address debts in accordance with the Comprehensive Mediated Settlement Agreement, to be signed and attached to the Decree of Dissolution of Marriage

9. TAX RETURNS: (check this box if this is what you want).

Cl

After the judge or commissioner signs the Decree of Dissolution of Marriage (Divorce), we will, subject to IRS Rules and Regulations, pay federal and state taxes as follows: For previous years (the years we were married, not including the year the Decree was signed), the parties will file joint federal and state income tax returns. In addition, for previous calendar years, both parties will pay, and hold the harmless from ‘/2 of all additional income taxes if any and other costs and each will share equally in any refunds. For the calendar year (the year that the Decree is signed) and all future calendar years. each party will, subject to IRS Rules and Regulations, file separate federal and state income tax returns. Each party will give the other party all necessary documentation to do so.

The parties agree to address tax returns in accordance with the Comprehensive Mediated Settlement Agreement, to be signed and attached to the Decree of Dissolution of Marriage.

10. SPOUSAL MAINTENANCEISUPPORT (ALIMONY) (check the box that applies to you):

El CI

Neither party is entitled to spousal maintenance/support (alimony), OR

Petitioner 0R D Respondent is entitled to spousal maintenancelsupport because: (Check one or more of the box(es) beiow that apply. At least one reason must apply to get spousal maintenance/support.)

Person lacks sufiicient property to provide for hisrher reasonable needs.

Person is unable to support himself/herself through appropriate employment.

Person is the custodian of a child(ren) whose age or condition is such that the person should not be required to seek employment outside the home.

Person lacks the learning ability in the labor market adequate to support himself/herself; and

D Person contributed to the educational opportunities of the other spouse or has a marriage of long duration and is now of an age that precludes the possibility of gaining employment adequate to support himself/herseif.

[:1 DEC]

The parties agree to address spousal maintenance in accordance with the Comprehensive Mediated Settlement Agreement, to be signed and attached to the Decree of Dissolution of Marriage.

11. WRITTEN AGREEMENT: (Check box only if true.)

E]

D

My spouse and l have a written agreement signed by both of us about the maintenance of a spouse. division of property/debt, where the children will live, authority for legal decision- making concerning the children (legal custody), parenting time and child support; and

I have attached a copy of the written agreement.

The parties are in the process of mediating will submit a written agreement that will be attached to the Decree of Dissolution of Marriage.

Page 4 of 6Case Number:

REQUESTS TO THE COURT:

A.

DISSOLUTION (DIVORCE):

D Dissolve our marriage and return each party to the status of single person;

RESTORE NAME:

I took the name of my spouse at the time of marriage and i want to restore my last name to the

name I used before this marriage or to my maiden name. My complete married name is:

I want my name restored to: (List complete maiden name or legai name before the marriage):

WARNING: If you are not the person who is requesting to have your form name restored, the court must

have a written request from the party who wants his or her name restored to change the name.

SPOUSAL MAINTENATNCE (ALIMONY): I] Order spousal support to be paid by El Wife, or [3 Husband in the amount of per month beginning with the first day of the month after the Judicial Officer signed the Decree and continuing until the person receiving spousal maintenance remarries or either party is deceased, or for a period of months. These payments, and a fee for handling, will be paid through the Support Payment Clearinghouse.

COMMUNITY PROPERTY: Make a fair division of all community property.

COMMUNITY DEBTS: Order each party to pay community debts as requested in the Petition,

and to pay any other community debts unknown to the other party. Order each party to pay and

hold the other party harmless from debts incurred by himlher since the parties separation on or the date the Respondent was served with the Petition for Dissolution.

SEPARATE PROPERTY: Award each party hislher separate property and make each party pay hislher own separate debt. ‘

OTHER ORDERS I AM REQUESTING (Explain request here):

~_________________.____._—___———-———-———-—————-———-—-

W

Page 5 of 6Case Number:

OATH OR AFFIRMATION OR VERIFICATION

I swear or affirm that the information on this document are true and correct

flax/{Wail .5M‘ 6“ (r Signa ure Date Sworn to or affirmed before me this: ?//;’ by E /‘/512 4,. 71;.

Printed Name

f é % ,2; £4 /é Seal/My Co mission Expi 5: Deputy Clerk or Notary Public

NOTARY PUBLIC STATE OF ARIZOHA

under penalty of perjury.

-. ‘ in; TINA BAKER,

‘tmfi‘ hymen-uqu .4… . q“

Page 6 of 6

flSnrwrinr P.an nf Ari-mna in Marianna (Ir-mu nnl on 4 n5 n4 n4 4 a

donna_desantis_vs_john_lagos

t ‘ FILED BY ’- Name of Person Filing: Donna M. DeSantis ‘

In this case I am: lZl Petitioner [3 Respondent ~ “mew, In this case I am: E Representing Myself (No Attorney), or M‘Cfigg tagmmmc» If Represented by Attorney: Attorney Bar Number: mBH-fi‘fipogfit be My Address: (if not protected) 11132 E. Villa Park Street ‘ _ _ 7 0’” City, State, Zip Code: Chandler Arizona 1 ‘ . .. ‘ Telephone Numbers: (480) 782-5551 3 OCT ‘8 PHD I”: 35 U’ SUPERIOR COURT OF ARIZONA IN MARICOPA COUNTY PAID

DONNA M. DESANTIS Case Number: ft; 2 O I 3 – U 9 4 5 2 5,

Petitioner ATLAS Number: (if applicable) JOHN M!CHAEL LAGOS PETITION FOR DISSOLUTION OF A Respondent NON-COVENANT MARRIAGE (DIVORCE)

WITH MINOR CHILDREN STATEMENTS TO THE COURT, UNDER OATH OR AFFIRMATION:

1. INFORMATION ABOUT ME, THE PETITIONER:

Name: Donna M. DeSantis Address: 11132 East Villa Park Street, Chandler, Arizona 85248 Date of Birth: July 24, 1955

Job Title: Physician l have lived in Arizona for 21 years andlor months

2. INFORMATION ABOUT THE RESPONDENT:

Name: John Michael Lagos Address: 11132 East Villa Park Street, Chandler, Arizona 85248

Date of Birth: June 12, 1959

Job Title: Proiect Manager Respondent has lived in Arizona for 21 years and/or __ months

3. INFORMATION ABOUT, MY THE MARRIAGE:

Date of Marriage: Au ust 2 1986 City and state, or country where we were married: East Lansdowne, Pennsylvania

The following statements MUST BE TRUE for you to use this document and to qualify for divorce in Arizona AND you must check the boxes to indicate that the statements are true or your case may not proceed.

EWe do not have a covenant marriage (if not sure, refer to the lNSTRUCTIONS for information). Our marriage is broken beyond repair (“irretrievably broken’) and there is no hope of reconciliation.

We have tried to resolve our problems through Conciliation Services or going to Conciliation Services would not work.

This court has jurisdiction to determine physical custody and authority for legal decision- making (legal custody) over our minor child(ren) common to the parties because the minor child(ren) haslhave lived with Petitioner or Respondent in Arizona for at least the past 6 months.

4. 90 DAY REQUIREMENT: (This statement MUST be true before you can file for divorce in Arizona). I OR [:I my spouse have lived, in Arizona or have been stationed in Arizona while a member of the Armed Forces, for at least 90 days before I filed this action

Page 1 of 8Case Number:

DOMESTIC VIOLENCE: (if you intend to ask for joint iega/ decision making authority (faint custody), there must have been no significant domestic violence in your marriage. A.R.S. 25—40303.

Check the box to make a true statement): Significant domestic violence, [:1 has OR E has not occurred during this marriage.

The parties agree address division of property in accordance with the Comprehensive Mediated Settlement Agreement, to be signed and attached to the Decree of Dissolution of Marriage.

CHILDREN OF THE PARTIES WHO ARE LESS THAN 18 YEARS OLD:

Listed below are children still under the age of 18 born to or adopted by my spouse and me during our marriage, or where indicated, born before. Husband is the father of the children listed below.

Child’s Name: Jessica Taylor Lagos

Birthdate: November 1 1996 El Born prior to marriage Address: 11132 E. Villa Park Street, Chandler, AZ 85248

Length of Time at Address: 2 years

Child’s Name: Michael John Lagos

Birthdate: June 1 1999 El Born prior to marriage

Address: 11132 E. Villa Park Street, Chandler, AZ 85248 Length of Time at Address: 2 years

Child’s Name:

Birthdate: Cl Born prior to marriage

Address: Length of Time at Address:

Child‘s Name:

C] Born prior to marriage

Birthdate: . ._____.._______——

Address: Length of Time at Address:

PREGNANCY and PATERNITY: (Check one box)

>14 Wife is not pregnant, OR

B Wife is pregnant.

The baby is due on (date), (and, check one box below): I] The Petitioner and Respondent are the parents of the child, OR [Z] Husband is not the parent of the child, OR

E The Petitioner and Respondent are the parents of the child, OR

[3 Petitioner is not the parent of the child, 0R.

Page 2 of 88.a.

Case Number:

I: Respondent is not the parent of the child.

[3 A minor child or minor children were born before the marriage. The husband is the father of that minor childlthose minor children named below. 7 7

COMMUNITY PROPERTY. (Check one box)

I] My spouse and I did not acquire any community property during the marriage, OR [:1 My spouse and I acquired community property during the marriage, and we should divide it as follows:

Petitioner Respondent Value

[3 Real Estate IOCated [:l [I

The parties agree to address division of property in accordance with the Comprehensive Mediated Settlement Agreement, to be signed and attached to the Decree of Dissolution of Marriage.

E] Household furniture and appliances: Petitioner Respondent Value [I [II $____ El E1 $____

The parties agree to address division of property in accordance with the Comprehensive Mediated Settlement Agreement, to be signed and attached to the Decree of Dissolution of Marriage.

B Household furnishings: Petitioner Respondent Value 13 E] $.— D E] $— 12! D $______

The parties agree to address division of property in accordance with the Comprehensive Mediated Settlement Agreement, to be signed and attached to the Decree of Dissolution of Marriage.

I] Other items: Petitioner Respondent Value El El 35—…— D D $___.__ El E] $___

The parties agree to address division of property in accordance with the Comprehensive Mediated Settlement Agreement, to be signed and attached to the Decree of Dissolution of Marriage.

I] Pensionlretirement fundlprofit sharinglstock planl401 K: (See Attachment)

Petitioner Respondent Value D II! $____ [3 E] s D E] $_______

The parties agree to address division of property in accordance with the Comprehensive Mediated Settlement Agreement, to be signed and attached to the Decree of Dissolution of Marriage.

Page 3 of 88.b.

9.a.

9.1).

10.

Case Number:

El Motor vehicles: Petitioner Respondent Value Make: Year: __ E) CI 3 Model: El D VIN:

Lien Holder:

The parties agree to address division vehicles in accordance with the Comprehensive Mediated Settlement Agreement, to be signed and attached to the Decree of Dissolution of Marriage.

SEPARATE PROPERTY: (Check all boxes that apply.)

I do not have any property that I brought into the marriage or separate property.

My spouse, the Respondent does not have any property that he or she brought into the marriage or separate property.

I have property that brought into the marriage or I have separate property. i want this property awarded to me as described below. .

My spouse, the Respondent, has property that he or she brought into the marriage or has separate property. I want this property awarded to my spouse as described below.

DUDE

Separate Property: (On the next page. list the property and the value of the property, and check the box to tell the court who should get the property.)

Description of Separate Property Petitioner Respondent Value III I] s EI III $—

The parties agree to address division of property in accordance with the Comprehensive Mediated Settlement Agreement, to be signed and attached to the Decree Dissolution of Marriage.

COMMUNITY DEBTS: (check one box)

E] My spouse and I did not incur community debts during the marriage, OR [3 We should divide the responsibility for the debts incurred during the marriage as follows:

DESCRIPTION OF DEBT Petitioner Respondent Amount Owed E] E] $ El E] $.— EI III $

SEPARATE DEBTS: (check all boxes that appiy.) E] My spouse and I do not have any debts that were incurred prior to the marriage or separate debt; [I i have separate debt or debt that I incurred prior to the marriage which should be paid by

me as described below; [I My spouse has separate debt or debt that he or she incurred prior to the marriage that should be paid by my spouse as described below.

Petitioner Respondent

CI El ‘—

The parties agree to address debts in accordance with the Comprehensive Mediated Settlement Agreement, to be signed and attached to the Decree of Dissolution of Marriage

TAX RETURNS: (check this box if this is what you want). C] After the judge or commissioner signs the Decree of Dissolution of Marriage (Divorce), we

Page 4 of 8Case Number:

will. subject to IRS Rules and Regulations, pay federal and state taxes as follows: For previous years (the years we were married, not including the year the Decree was signed), the parties will file joint federal and state income tax returns. in addition, for previous calendar years, both parties will pay, and hold the harmlessfrom 1/z of all additional income taxes if any and other costs and each will share equally in any refunds. For the calendar year (the year that the Decree is signed) and all future calendar years, each party will, subject to IRS Rules and Regulations. file separate federal and state income tax returns. Each party will give the other party all necessary documentation to do so.

The parties agree to address tax returns in accordance with the Comprehensive Mediated

Settlement Agreement, to be signed and attached to the Decree of Dissolution of Marriage.

11. SPOUSAL MAINTENANCEISUPPORT (ALIMONY) (check the box that applies to you): El Neither party is entitled to spousal maintenancelsupport (alimony), 0R

E] Petitioner OR [:1 Respondent is entitled to spousal maintenanceisupport because: (Check one or more of the box(es) below that apply. At least one reason must apply to get spousal maintenancelsupport.)

Person lacks sufiicient property to provide for his/her reasonable needs.

Person is unable to support himself/herself through appropriate employment.

Person is the custodian of a child(ren) whose age or condition is such that the person should not be required to seek employment outside the home.

Person lacks the learning ability in the labor market adequate to support himself/herself; and ‘

D Person contributed to the educational opportunities of the other spouse or has a marriage of long duration and is now of an age that precludes the possibility of gaining

employment adequate to support himself/herself. The parties agree to address spousal maintenance in accordance with the Comprehensive Mediated

Settlement Agreement, to be signed and attached to the Decree of Dissolution of Marriage.

El EDD

12. WRITTEN AGREEMENT: (Check box only if true.)

D My spouse and l have a written agreement signed by both of us about the maintenance of a spouse. division of property/debt, where the children will live. authority for legal decision- making concerning the children (legal custody). parenting time and child support; and

[j l have attached a copy of the written agreement. The parties are in the process of mediating will submit a written agreement that will be attached to the Decree of Dissolution of Marriage.

REQUESTS TO THE COURT:

A. DISSOLUTION (DIVORCE):

Dissolve our marriage and return each party to the status of single person;

RESTORE NAME:

I took the name of my spouse at the time of marriage and I want to restore my last name to the

name I used before this marriage or to my maiden name. My comglete married name is:

i want my name restored to: (List complete maiden name or legal name before the marriage):

m

WARNING: If you are not the person who is requesting to have your form name restored. the court must have a written request from the party who wants his or her name restored to change the name.

Page 5 of 8Case Number:

8. PATERNITY and MINOR CHILD(REN)’S NAMES: Declare the husband to be the father of the following named minor child(ren) born before marriage and (optional) change the legal name of those minor children to be the name listed on the right below.

Current Legal Name (OPTIONAL) Change the name of the child to:

New Name _I_ —I— —I—

C. PRIMARY RESIDENTIAL PARENT, PARENTING TIME, AND AUTHORITY FOR LEGAL DECISION MAKING (CUSTODY):

The parties agree to address all legal decision making (custody) and parenting time issues in accordance with the Comprehensive Mediated Settlement Agreement, to be signed and attached to

the Decree of Dissolution of Marriage.

Declare which parent shall be “Primary Residential Parent” for each minor child as follows:

E] Declare Mother as primary residential parent for the following named children:

C] Declare Father as primary residential parent for the following named children:

Subject to parenting time, as follows:

C.1 . PARENTING TIME: Award parenting time as follows: E] Reasonable Parenting time rights to the non-primary residential parent, OR

I] Supervised parenting time between the children and I] Mother OR I] Father OR

[I a No parenting time rights to D Mother OR [3 Father.

Supervised or no parenting time is in the best interests of the childtren) becausez”

[j Explanation continues on attached pages made a part of this document by reference.

a. Name this person to supervise: b. Restrict parenting as follows

c. Order cost of supervised parenting time (if applicable) to be paid by: 1:] Mother El Father, OR 1:! Shared equatly by the parties.

Page 6 of 80.2.

Case Number:

AUTHORITY FOR LEGAL DECISION MAKING (CUSTODY): Award legal authority to make decisions concerning the child(ren) as follows:

El AWARD SOLE AUTHORITY FOR LEGAL DECISION-MAKING to: D Mother D Father

0R E AWARD JOINT AUTHORITY FOR LEGAL DECISION-MAKING to BOTH PARENTS

Mother AND Father agree to act as joint legal decision makers concerning the minor child(ren) and will submit a Parenting Plan and Joint Legal Decision Making Agreement signed by both parties. (For the court to order “joint legal decision making, there must have been no “significant” domestic violence according to Arizona law. A.R.S. § 25—40303)

CHILD SUPPORT: Order that child support will be paid by: D Petitioner OR D Respondent in a reasonable amount as determined by the court under Arizona Child Support Guidelines. Support payments will begin on the first day of the first of the entry of the divorce decree. These payments. and a fee for handling, will be paid through the Support Payment Clearinghouse and collected by automatic Income Withholding Order.

MEDICAL, DENTAL, VISION CARE FOR MINOR CHILDREN: Order that

D Mother is responsible for providing: D medical D dental D vision care insurance. D Father is responsible for providing: D medical D dental D vision care insurance.

Petitioner and Respondent will pay for all reaSOnabIe unreimbursed medical, dental, and health- related expenses incurred for the child(ren) in proportion to their respective incomes.

TAX EXEMPTION: The parties will claim the children as income tax dependency exemption on federal and state income tax returns as follows:

Parent entitled to claim Name of child in Tax Year: D M III F D M Cl F D M D F El M El F

D Pattern shall repeat for subsequent years.

SPOUSAL MAINTENATNCE (ALIMONY): D Order spousal support to be paid by D Wife, or D Husband in the amount of per month beginning with the first day of the month after the Judicial Officer signed the Decree and continuing until the person receiving spousal maintenance remarries or either party is deceased, or for a period of months. These payments, and a fee for handling, wilt be paid through the Support Payment Clearinghouse.

COMMUNITY PROPERTY: Make a fair division of all community property.

COMMUNITY DEBTS: Order each party to pay community debts as requested in the Petition, and to pay any other community debts unknown to the other party. Order each party to pay and hold the other party harmless from debts incurred by himlher since the parties separation on

Page 7 of 8Case Number

or the date the Respondent was served with the Petition for Dissolution.

J. SEPARATE PROPERTY: Award each party hisfher separate property and make each party pay his/her own separate debt; ‘ ‘

The parties agree to address all spousal maintenance, property and debt issues in accordance with the Comprehensive Mediated Settlement Agreement, to be signed and

attached to the Decree of Dissolution of Marriage.

K. OTHER ORDERS I AM REQUESTING (Explain request here):

__________________________.__.____.__—-————————————— __________________________________———-——-—-—-————————-

OATH OR AFFIRMATION OR VERIFICATION

I swear or affirm that the information on this document are true and correct under penalty of perjury.

@ij 3:! 112 raflgr :

Signature Date Sworn to or affinned before me this: C I; i: Q . 9-0 B by e I0l . Tl

Printed Name

Seal/My Commission Expires: Deputi rglerk or Notary guélc I i

OFFICIAL SEAL PAMELA J.TIRPAK Notary Public – Arizona ‘ ‘ « MARICOPA COUNTY ‘ My Commission Expires JANUARY 31. 2016

Page 8 of 8