Name of Person Filing: Your Address: Your City, State, Zip code: Your Telephone Number: ATLAS Number (if applicable): Self (Without an Attorney) OR Representing Plaintiff OR Defendant Attorney for For Clerk's Use Only SUPERIOR COURT OF ARIZONA IN MARICOPA COUNTY Case No. (Name of Plaintiff) APPLICATION AND AFFIDAVIT FOR DEFAULT (Civil Cases Only) (Name of Defendant) NOTICE: THIS IS AN IMPORTANT COURT DOCUMENT. When this document is properly completed and filed, Default has been applied for and entered. The Default will be effective ten (10) working days after the filing of this completed document, unless the Defendant files an Answer/Response or otherwise defends before the ten working day period expires. UNDER OATH OR BY AFFIRMATION 1. I am the Plaintiff in this court case. I understand and make the following statements under oath or by affirmation. I give notice that I am requesting entry of default against the other party, the Defendant, because the Defendant has not filed an Answer/Response. Service of the court papers on Defendant has been accomplished as follows: (check ONLY one box) The Defendant has signed an "Acceptance of Service" and has accepted service of the "Summons," Complaint and other papers. The Defendant has not filed an "Answer/Response", or otherwise appeared or defended in this court case. Default may be entered. OR I have served the Defendant according to law with the "Summons," Complaint and other papers. Defendant has not appeared, answered, responded or otherwise defended in the time required by law. 3. 4. The Defendant is either not in the active military service of the United States or has otherwise waived his/her rights under the Service Members Civil Relief Act (formerly "Soldiers and Sailor's Civil Relief Act"). By completing the Certificate of Mailing or Delivery at the bottom of this form, I certify that I am mailing or delivering a copy of this Application and Affidavit to the Defendant as notice that I have applied for default and default has been entered in this court case. Check all boxes that are true: I have mailed a copy of this Application and Affidavit to the Defendant at his/her last known address, OR GN61f-032311 Page 1 of 2 American LegalNet, Inc. www.FormsWorkFlow.com 2. 5. ©Superior Court of Arizona in Maricopa County ALL RIGHTS RESERVED AAD Case No. IF I know the Defendant, who I claim to be in default, is represented by an attorney, I have also mailed a copy of this Application and Affidavit to that attorney, OR I have not mailed a copy of this Application and Affidavit to the Defendant because I do not know his/her location or whereabouts and do not believe the Defendant is represented by an attorney. (You can only check this box, if the Defendant was served by publication.) Note: If the Defendant fails to file a responsive pleading or otherwise defend in this action within 10 working days of the filing of this Application, a default judgment will be entered. The Plaintiff must still attend the default hearing at the court. UNDER OATH OR BY AFFIRMATION Plaintiff Signature (sign in front of Court Clerk/Notary) Sworn to or Affirmed before me: Date My Commission Expires/Seal (below) Deputy Clerk or Notary Public Date CERTIFICATE OF MAILING As required by Arizona Rules of Court (A.R.C.P. 55(a) and A.R.F.L.P. 44(A)). 20____, a copy of this Application and Affidavit for On (date) Default was mailed, postage-prepaid, to the Respondent at his/her: current address (as listed below), OR (if current address is unknown) his/her last known address, as listed below: (address, city, state) IF I know the Respondent, who I claim to be in default, is represented by an attorney, I have also mailed a copy of this Application and Affidavit to that attorney. ©Superior Court of Arizona in Maricopa County ALL RIGHTS RESERVED GN61f-032311 Page 2 of 2 American LegalNet, Inc. www.FormsWorkFlow.com AAD