For Clerk’s Use Only Name of Person Filing: Mailing Address: City, State, and 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 In the Marriage of: Case Number: (Name of Petitioner) MOTION AND AFFIDAVIT FOR DEFAULT DIVORCE WITHOUT A COURT HEARING AND (Name of Respondent) STATE OF ARIZONA County of Mohave ) ) ) ss. I am the Petitioner and I am asking the court to enter a “Decree of Dissolution of Marriage by Default Without a Court Hearing.” (Rule 55(b)(1)(ii), Arizona Rules of Civil Procedure.) I have put a check mark in each box in front of the statements below that are true and I understand that if any statement is not true, I cannot get a default divorce without a hearing. I have read this “Motion and Affidavit for Default Divorce Without a Court Hearing” and to the best of my knowledge everything I have said is true. I have paid the filing and service fees or the filing and service fees have been waived or deferred. A copy of the receipt showing payment or a copy of the Order showing that the fees have been waived or deferred is attached. I am competent and sane. To the best of my knowledge, Respondent is competent and sane. At least 64 days have passed since the Respondent was served with the dissolution papers. Service was not done by publication. The Respondent has not made an appearance in this matter or filed a “Response.” I have filed the “Application for Default” and Default has been entered against the Respondent. I have or Respondent has lived in the State of Arizona for a least 90 consecutive days prior to the date the Petition for Dissolution was filed. Conciliation Services provisions have been met since the filing of the Petition for Dissolution of Marriage or the provisions do not apply. (A.R.S. 25-381.09). The marriage is irretrievably broken. February 2, 2006 Page 1 of 2 American LegalNet, Inc. www.FormsWorkflow.com Case No._________________ There are no minor children, common to the parties, who were born before or during the marriage, or who were adopted by the parties during the marriage. Petitioner/Respondent, to my knowledge, is not pregnant. Neither the Petitioner nor the Respondent has any interest in real property (for example, land or houses). Neither Petitioner nor Respondent has made a claim for spousal maintenance/support. A claim for spousal maintenance/support is deemed waived by both parties. The total amount of bills and debts incurred by the parties during the marriage is less than $10,000. The total fair market value of community assets is less than $15,000, after the parties subtract any monies owed on the assets. I have listed the assets and the value of each asset on the attached piece of paper. All of the allegations, including those concerning property and debts listed in the “Petition for Dissolution of Marriage” were true at the time I filed the “Petition for Dissolution of Marriage” and remain true as of the date of the filing of this Motion and Affidavit. If the allegations are no longer true, you need to tell the court why the allegations are no longer true. ___________________________________________________________________________________ ___________________________________________________________________________________ Everything in the “Petition for Dissolution of Marriage” concerning who gets the property and who pays the bills/debts is fair and reasonable. If applicable, attorney fees are itemized on the paper attached to this Motion and Affidavit. The relief to be awarded in the “Decree of Dissolution of Marriage” is the same as the relief requested in the “Petition for Dissolution of Marriage” OR if the relief to be awarded is different, it has been approved by both parties, as reflected in the “Decree of Dissolution of Marriage” and signed by both parties. Therefore, I request this court to sign the attached “Decree of Dissolution of Marriage.” OATH AND VERIFICATION STATE OF ARIZONA ) )ss. County of _________________) The contents of this document are true and correct to the best of my knowledge and belief. I acknowledge that any false statement may subject me to penalties relating to perjury. __________________________________________ Signature _____________________________ Date SUBSCRIBED AND SWORN TO before me this ____________ day of __________________, 20_________ by______________________________________. ____________________________ My Commission Expires February 2, 2006 __________________________________________ Notary Public / Deputy Clerk Page 2 of 2 American LegalNet, Inc. www.FormsWorkflow.com