Name of Person Filing Document: Your Address: Your City, State, and Zip Code: Your Telephone Number: Attorney Bar Number (if applicable): Representing Self (Without an Attorney) OR Attorney for Petitioner OR Respondent FOR CLERK'S USE ONLY SUPERIOR COURT OF ARIZONA IN MARICOPA COUNTY Case Number: Name of Petitioner/Plaintiff . REQUEST AND ORDER FOR HEARING Name of Respondent/Defendant. NOTICE: To ensure that the Consent Judgment is not entered, you must mail or hand-deliver a copy of this document to the Clerk of the Court, Collections Department, 201 West Jefferson, 1st Floor, Phoenix, Arizona 85003. Check at least one of the following: I request a hearing on the denial of my supplemental application for waiver or further deferral. I do not agree with the amount of unpaid fees and costs on the itemized statement provided by the court. I request a hearing on the calculation of the unpaid fees and/or costs. Date: Print your name: . Signature: THE COURT COMPLETES THE FOLLOWING SECTION IT IS ORDERED scheduling a hearing on the above matter. Hearing Date: Hearing Time: Hearing Location: Hearing Officer: Dated: Judicial Officer OR Mailed/hand-delivered to applicant on , by Special Commissioner © Superior Court of Arizona in Maricopa County August 16, 2007 ALL RIGHTS RESERVED Page 1 of 1 GNF31f Use current form ROH American LegalNet, Inc. www.FormsWorkFlow.com