Name: ___________________________________ Address: _________________________________ City, State, ZIP: ____________________________ Daytime Telephone No: ______________________ Representing Self, Without a Lawyer ARIZONA SUPERIOR COURT, PIMA COUNTY ______________________________________ Case No. _________________ Petitioner and ORDER REGARDING DEFERRAL OF COURT FEES AND/OR COSTS AND CONSENT TO ENTRY OF JUDGMENT ______________________________________ Respondent THE COURT FINDS that the applicant (print name): : 1. † IS NOT ELIGIBLE FOR A DEFERRAL of court fees and costs; OR 2. † IS ELIGIBLE FOR A DEFERRAL of fees and costs based on financial eligibility. As required by state law, the applicant has signed a consent to entry of judgment; OR 3. † IS ELIGIBLE FOR DEFERRAL of fees and costs at the court’s discretion (A.R.S. §12-302(L)); OR 4. † IS ELIGIBLE FOR DEFERRAL of fees and costs based on good cause shown. As required by state law, the applicant has signed a consent to entry of judgment; OR 5. † IS ELIGIBLE FOR WAIVER of fees and costs because the applicant is permanently unable to pay; OR 6. † IS ELIGIBLE FOR WAIVER of fees and costs at the court’s discretion (A.R.S. §12-302(L)); OR 7. † IS NOT ELIGIBLE FOR WAIVER of fees and costs. IT IS ORDERED: † DEFERRAL DENIED for the following reason(s): † The application is incomplete because _________________________________________________ ________________________________________________________________________________ You are encouraged to submit a complete application. † The applicant does not meet the financial criteria for fee deferral because _____________________ ________________________________________________________________________________ A deferral MUST BE granted if the applicant is receiving public assistance benefits or has an income that is insufficient or barely sufficient to meet the daily essentials of life and that includes no allotment that could be budgeted to pay the fees and/or costs necessary to gain access to the court or if the applicant demonstrates other good cause. 1 deferral-order.form Revised 02.11.11 American LegalNet, Inc. www.FormsWorkFlow.com † DEFERRAL GRANTED for the following fees and/or costs in this court: † Any or all filing fees for the issuance of summonses and subpoenas, fees for obtaining one certified copy of a temporary order in a domestic relations case, or a final order, judgment or decree in all civil proceedings, child support payment history report or fees for attending Domestic Relations Education on Children’s Issues Program pursuant to A.R.S. §25-352. † Fees for service of process by a sheriff, marshal, constable or local law enforcement agency † Fees for service by publication † Filing fees and photocopy fees for the preparation of the record on appeal † Court reporter’s fees of reporters or transcribers employed by the court for the preparation of the transcript. IF A DEFERRAL IS GRANTED, PLEASE CHECK ONE OF THE FOLLOWING BOXES. † † † NO PAYMENTS WILL BE DUE UNTIL FURTHER NOTICE. SCHEDULE OF PAYMENTS. The applicant shall pay $ ________________ each ______________ (week, month etc.) until paid in full, beginning________________________________. WAIVER DENIED for all court fees and costs of this case that may be waived under A.R.S. §12-302(I) because of: † † † Applicant’s lack of proof of a permanent inability to pay court fees and/or costs. Reasons determined by the court. WAIVER GRANTED for all fees and/or costs of this case that may be waived under A.R.S. §12-302(l) because: † Applicant’s proof of a permanent inability to pay court fees and/or costs. † Reasons determined by the court. Right to judicial review. If the application is denied or a payment schedule is set by a special commissioner, you may request the decision be reviewed by a judge or judicial officer. The request must be made within twenty (20) days of the day the order was mailed or delivered to you. If a schedule of payments has been established, payments shall be suspended until a decision is made after the judicial review. The judicial review shall be held as soon as possible. CONSENT TO ENTRY OF JUDGMENT. In accordance with state law and procedures adopted by the Arizona Supreme Court, a consent judgment shall be entered against the applicant for all fees and costs that are deferred and not taxed to another party, but that remain unpaid after thirty (30) calendar days following the entry of final judgment unless any one of the following applies: A. Fees and costs are taxed to another party; B. A supplemental application for waiver or further deferral remains pending; C. The court orders that the fees and costs be waived or further deferred; or D. Within twenty days of the date the court denies the supplemental application, the applicant: 1. Pays the fees; or, 2. Requests a hearing on the court’s order denying waiver or further deferral. If the applicant requests a hearing, the court shall not enter the consent judgment unless a hearing is held. Waiver or further deferral is denied and payment has not been made within the time prescribed by the court. 2 deferral-order.form Revised 02.11.11 American LegalNet, Inc. www.FormsWorkFlow.com If an appeal is taken, a consent judgment for deferred fees and costs that remain unpaid in the lower court shall not be entered until thirty (30) days after the appeals process is concluded. The procedures for notice of court fees and costs and for entry of a consent judgment continue to apply. If a consent judgment is signed and the applicant pays the fees and costs in full, the court is required to comply with the provision of A.R.S. §33-964(C). DUTY TO REPORT CHANGE IN FINANCIAL CIRCUMSTANCES. An applicant who is granted a deferral shall promptly notify the court of the change in financial circumstances during the pendency of the case that would affect the applicant’s ability to pay court fees and costs. Any time the applicant appears before the court on this case, the court may inquire as to the applicant’s financial circumstances. DATED: ________________________________________ Signature, Judicial Officer 3 deferral-order.form Revised 02.11.11 American LegalNet, Inc. www.FormsWorkFlow.com