For Clerk’s Use Only Name of Person Filing: __________________________________________ Mailing Address: __________________________________________ City, State, Zip Code: __________________________________________ Your Telephone Number(s): __________________________________________ ATLAS Number (if applicable):__________________________________________ State Bar Number (if applicable):________________________________________ Self (Without an Attorney) OR Representing Attorney for Petitioner Respondent SUPERIOR COURT OF ARIZONA MOHAVE COUNTY Case No._______________________________ (Name of Petitioner) APPLICATION AND AFFIDAVIT FOR DEFAULT _____________________________________ (Name of Respondent) 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) days after the filing of this completed document, unless the Defendant/Respondent files an Answer/Response or otherwise defends before the ten day period expires. 1. I am the Petitioner in this court case. I understand and make the following statements under oath. I give notice that I am requesting entry of default against the other party, the Respondent, because the Respondent has not filed an Answer/Response. 2. Service of the court papers on Respondent has been accomplished as follows: (check ONLY one box) The Respondent has signed an “Acceptance of Service” and has accepted service of the “Summons,” Complaint or Petition and other papers. The Respondent has not filed an “Answer/Response,” or otherwise appeared or defended in this court case. Default may be entered. OR I have served the Respondent according to law with the “Summons,” Complaint or Petition and other papers. Respondent has not appeared, answered, responded or otherwise defended in the time required by law. 3. The Respondent 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 “Soldier's and Sailor's Civil Relief Act”). 4. 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 Respondent as notice that I have applied for default and default has been entered in this court case. 5. Check all boxes that are true: I have mailed a copy of this Application and Affidavit to the Defendant/Respondent at his/her last known address, OR 4/30/2010 Page 1 of 2 American LegalNet, Inc. www.FormsWorkFlow.com Case No.___________________________ 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, OR I have not mailed a copy of this Application and Affidavit to the Respondent because I do not know his/her location or whereabouts and do not believe the Respondent is represented by an attorney. (You can only check this box, if the Respondent was served by publication.) NOTE: If the Respondent fails to file a responsive pleading or otherwise defend in this action within 10 days of the filing of this Application, a default judgment will be entered. The Plaintiff or Petitioner must still attend the default hearing, or if this is a Family Court case not involving minor children and you otherwise qualify, apply for and complete the process to obtain a default decree without a hearing. OATH OR AFFIRMATION STATE OF ARIZONA County of Mohave ) ) ss: ) I swear or affirm the contents of this document are true and correct under penalty of perjury. __________________________________________________ Signature ______________________ Date SUBSCRIBED AND SWORN to before me this _____________day of _______________, ________ by Printed Name of Person Who Signed My Commission Expires: __________________________ ____________________________ Deputy Clerk or Notary Public CERTIFICATE OF MAILING OR DELIVERY On (date) a copy of this document was: (check ONLY one box) mailed postage pre-paid, OR delivered by (name of person who did the delivery) to the Defendant/Respondent at the following: Address: ________________________________________________________________________ Your signature: ___________________________________________________________________ 4/30/2010 Page 2 of 2 American LegalNet, Inc. www.FormsWorkFlow.com