(A) Name: Mailing Address: Daytime Telephone Representing Self, Without a Lawyer IN THE SUPERIOR COURT OF ARIZONA, YAVAPAI COUNTY Regarding the matter of (C) DO APPLICATION AND AFFIDAVIT FOR DEFAULT (B) Petitioner/Plaintiff vs. (B) Respondent/Defendant NOTICE: THIS IS AN IMPORTANT DOCUMENT. When this document is properly completed and filed, Default has been applied for and may be entered. The Default, if entered, will be effective ten (10) days after the filing of this completed document, unless the Respondent files a Response or otherwise defends before the ten day period expires. This ten day period does not include Saturdays, Sundays or legal holidays. STATE OF ARIZONA County of Yavapai ) ) ss. 1. I am the Petitioner in this case. I understand and make the following statements under oath. I give notice that I am requesting Entry of Default against the Respondent because the Respondent did not file a Response, or otherwise appear or defend in this case in the time required by law. 2. Service of the court papers on Respondent was accomplished as follows: [ ] The Respondent signed an Acceptance of Service of the Summons, Petition and other papers. OR [ ] The Respondent has been served with the Summons, Petition and other papers by: (Mark one) [ ] Registered process server [ ] Publication [ ] Other OR OR [ ] Sheriff OR [ ] Certified/Registered/Restricted delivery/Return Receipt Requested or National Courier Service 3. [ ] The Respondent is either not in the active military service of the United States or has otherwise waived his or her rights under the Soldier's and Sailor's Civil Relief Act. 4. By completing the following Certificate of Mailing or Delivery, I certify that I am mailing or delivering a copy of this Application and Affidavit to the Respondent or to the attorney I know is representing the Respondent, who I claim is in default, as notice that I have applied for default and default may be entered in this case. Superior Court of Arizona in Yavapai County January 2006 Page 1 of 2 GN61f American LegalNet, Inc. www.FormsWorkFlow.com CERTIFICATE OF MAILING OR DELIVERY On (date) [ ] mailed postage pre-paid, OR , a copy of this document was: [ ] hand-delivered by (name of person who did the delivery) OR [ ] faxed if an appearance has been made to the Respondent or attorney at the following address/fax number: OR [ ] I have not mailed a copy of this Application and Affidavit to the Respondent because I do not know his or her location or whereabouts and do not believe the Respondent is represented by an attorney. I certify under penalty of perjury that the forgoing is true and correct. Date SIGNED ENTRY OF DEFAULT The Respondent has been properly served with the necessary papers in this case. The Respondent has failed to respond in the manner or time required by law. Default of Respondent is now entered. Dated: JEANNE HICKS Clerk of the Superior Court BY Deputy Clerk Superior Court of Arizona in Yavapai County January 2006 Page 2 of 2 GN61f American LegalNet, Inc. www.FormsWorkFlow.com