For Clerk’s Use Only Name of Person Filing: Mailing Address: City, State, Zip Code: Daytime Phone Number: Evening Phone Number: _______________________________________ ATLAS Number (if applicable): State Bar Number (if applicable):_____________________________________ Representing Self Petitioner Respondent SUPERIOR COURT OF ARIZONA MOHAVE COUNTY Case No. (Name of Petitioner) APPLICATION FOR DEFAULT AFFIDAVIT OF DEFAULT AND ENTRY OF 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. STATE OF ARIZONA County of Mohave ) ) ss. 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 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, AND 2/22/2006 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 at the court. STATE OF ARIZONA ) )ss: COUNTY OF __________________) Petitioner Signature (sign in front of Notary Public) SUBSCRIBED AND SWORN to before me this day of ________________, ________ by Notary Public / Deputy Clerk My Commission Expires:__________________ PETITIONER’S CERTIFICATE OF MAILING OR DELIVERY copy of this document was: (check ONLY one box) On (date) mailed postage pre-paid, OR delivered by (name of person who did the delivery) to the Defendant/Respondent at the following: Address: Signed: ENTRY OF DEFAULT The Respondent having been properly served with the necessary papers in this action and having failed to respond in the way or time required by law, the Default of Respondent is entered effective 10 days from date of this filing. Dated: _____________________________ VIRLYNN TINNELL CLERK OF THE SUPERIOR COURT By______________________________ Deputy Clerk 2/22/2006 Page 2 of 2 American LegalNet, Inc. www.FormsWorkflow.com