PIMA COUNTY CONSOLIDATED JUSTICE COURT 240 N. Stone Avenue, Tucson, AZ 85701 (520) 724-3171 PLAINTIFF CASE NO. ____________________________ REQUEST and AFFIDAVIT FOR ENTRY OF DEFAULT JUDGMENT (JCRCP 140) DEFENDANT (Name/Address/Phone): Without Hearing With Hearing (Name/Address/Phone): I request that the Court enter a default judgment. If I am the Plaintiff, then I state that the Summons, Complaint and the Notice to Defendant were served on the Defendant. No response has been received within the time allowed by law. At least (10) days have passed since the Entry of Default. The Defendant is is not on active duty in the United States Military. Principal Court Costs Attorney Fees Accrued Interest Other Attached are the: $ __________________ $ __________________ $ __________________ $ __________________ $ __________________ TOTAL $ _________________ Proposed Judgment Support documents/proof of debt Statement of Costs I state under penalty of perjury that the forgoing is true and correct. Date: _____________________ __________________________________________________________ Plaintiff Counterclaimant Third Party Plaintiff Attorney NOTE: A party who files a proposed default judgment must also provide the court with stamped envelopes addressed to each party. CERTIFICATE OF SERVICE I CERTIFY that I mailed a copy of this REQUEST and AFFIDAVIT FOR ENTRY OF DEFAULT JUDGMENT to: Plaintiff at the above address Plaintiff's Attorney Defendant at the above address Defendant's Attorney Date: _____________________ By: ________________________________________________________ Signature JP49B Created 1-17-06/(Rev 08-11-14) Original-Court Canary-Plaintiff Pink-Defendant American LegalNet, Inc. www.FormsWorkFlow.com