For Clerk's Use Only Name of Person Filing: _________________________________________ Mailing Address: _________________________________________ City, State, Zip Code: _________________________________________ Phone Number(s): _________________________________________ 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) IN FAMILY COURT CASES 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 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 or by affirmation. 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. 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. 2. 3. By completing the Certificate of Mailing or Delivery (on the next page), I certify to the Court that on the date of filing this document I will mail a copy of this Application and Affidavit to the Respondent at his or her current or last known address even if that is my own address and/or I have served the other party by publication, and if applicable, to his or her attorney as notice that I have applied for default. I UNDERSTAND THAT I WILL NOT QUALIFY FOR DEFAULT if: I fail to mail this document, and/or I fail to complete the Certificate of Mailing below: 4. Revised: 1/1/2013 Page 1 of 2 American LegalNet, Inc. www.FormsWorkFlow.com Case No.__________________________ CERTIFICATE OF MAILING As required by Arizona Rules of Court (A.R.C.P. 55a) and A.R.FL.P. 44(A)). A copy of this Application and Affidavit for Default will be mailed on the day of filing, postage-prepaid, to the current address, OR last known address (if current address is unknown) Respondent* at his/her of: _____________________________________________________________________________________ (street and number, including the apartment number, city and state, and zip code) * Mailing to current or last known address must be done even if last known address is your address and/or you know the Respondent is no longer at the last known address. (if applicable) I believe the Respondent whom I believe to be in default is represented by an attorney and have also mailed a copy of this Application and Affidavit for Default to that attorney. 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 WARNING 1. If the Respondent fails to file a responsive pleading or otherwise defend this action within 10 working days after the filing of this Application, A DEFAULT JUDGMENT MAY BE ENTERED. 2. The Petitioner must still attend the default hearing at the court UNLESS you qualify, apply for and complete the process to obtain a default decree without a hearing pursuant to A.R.F.L.P. 44(B)(1). 3. A DEFAULT HEARING WILL NOT BE SCHEDULED IF THIS APPLICATION AND AFFIDAVIT FOR DEFAULT IS MISSING INFORMATION OR NOT COMPLETED CORRECTLY. Revised: 1/1/2013 Page 2 of 2 American LegalNet, Inc. www.FormsWorkFlow.com