Page 1 of 3 DODefaultCOSCPinal03.20.18 Use only most current version Name of Person Filing: Street Address: City, State, Zip Code: Telephone Number: Email Address: ATLAS Number (if applicable): Representing Self (No Attorney) or Represented by Attorney If Attorney, Bar Number: SUPERIOR COURT OF ARIZONA PINAL COUNTY CASE NUMBER: S1100DO2 Name of Petitioner APPLICATION AND AFFIDAVIT FOR DEFAULT Name of Respondent HONORABLE: 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 they have 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 223Acceptance of Service224 and has accepted service of the 223Summons,224 Complaint or Petition and other papers. The Respondent has not filed an 223Answer/Response,224 or otherwise appeared or defended in this court case. Default may be entered. OR 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. American LegalNet, Inc. www.FormsWorkFlow.com Page 2 of 3 DODefaultCOSCPinal03.20.18 Use only most current version I have served the Respondent according to law with the 223Summons,224 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 Service Members Civil Relief Act (formerly 223Soldier's and Sailor's Civil Relief Act224). 4.By completing the Certificate of Mailing at the bottom of this form, 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 as notice that I have applied for default and default has been entered in this court case. 5.I UNDERSTAND THAT I WILL NOT QUALIFY FOR DEFAULT IF: I fail to mail this document, and I fail to complete the Certificate of Mailing below. CERTIFICATE OF MAILING As required by Arizona Rules of Court (A.R.C.P. 55(a) and A.R.F.L. 44(A)) A copy of the Application and Affidavit for Default will be mailed on the day of filing, postage pre-paid, to the Respondent at his/her current address, OR last known address (if current address is unknown) of: (street and number, including the apartment number, city and state, and zip code) I believe the Respondent whom I believe to be in default is represented by an attorney and have also mailed a copy of the Application and Affidavit for Default to that attorney at the address of: (Attorney222s name, street and number, including the apartment number, city and state, and zip code) 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 Petitioner must still attend the default hearing at the court. American LegalNet, Inc. www.FormsWorkFlow.com Page 3 of 3 DODefaultCOSCPinal03.20.18 Use only most current version OATH OR AFFIRMATION AND VERIFICATION: I swear or affirm that the information on this document is true and correct under penalty of perjury. Date Signature State of Arizona ) ) County of ) Subscribed and sworn (or affirmed) before me this day of , 20 (Day) (Month) (Year) by (Name of Signer) (Affix notary seal here) Notary Public (Notary222s Signature) American LegalNet, Inc. www.FormsWorkFlow.com