(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 MOTION & AFFIDAVIT FOR DEFAULT DECREE WITHOUT A HEARING - (B) Petitioner and Domestic Relations (B) Respondent STATE OF ARIZONA County of Yavapai ) ) ss. (D) I am the Petitioner in this case, and I am asking the Court to enter a Decree by default without a court hearing. (Rule 44 (B)(1), Arizona Rules of Family Law 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 pertaining to my case is not true, I cannot get a default decree without a hearing. GENERAL STATEMENTS: [ ] I am competent and sane. To the best of my knowledge, the other party is competent and sane or is represented by a guardian or other legally sufficient representative. [ ] The other party is not a minor or is a minor represented by a guardian or other legally sufficient representative. [ ] The other party 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 other party. [ ] The relief to be awarded in the accompanying Decree/Judgment/Order is the same as the relief I requested in the Petition. DISSOLUTION, LEGAL SEPARATION OR ANNULMENT PROCEEDINGS ONLY [ ] I have, or Respondent has, lived or been stationed as a member of the Armed Forces in the state of Arizona for at least 90 consecutive days prior to the date the Petition was field. [DISSOLUTION OR ANNULMENT ] [ ] I have, or Respondent has, lived or been stationed as a member of the Armed Forces in the state of Arizona prior to the date the Petition was field. [LEGAL SEPARATION] Superior Court of Arizona in Yavapai County January 2006 Page 1 of 2 CV62f American LegalNet, Inc. www.FormsWorkFlow.com [ ] Conciliation services provisions have been met since the filing of the Petition or the provisions do not apply. (A.R.S. § 25-381.09) [ ] The marriage is irretrievably broken. [DISSOLUTION] [ ] The parties wish to live separate and apart. [LEGAL SEPARATION] [ ] The marriage is void. [ANNULMENT] [ ] There are no minor children of the relationship of the parties who were born before or during the marriage, or who were adopted by the parties during the marriage. Wife, to my knowledge, is not pregnant. [ ] Both parties have waived spousal maintenance. [ ] The State is not a party to this case. [ ] The facts supporting my request(s) for relief in the sworn Petition filed (date) are incorporated into and made a part of this Motion and Affidavit. PATERNITY AND MATERNITY ONLY: [ ] I am the [ ] Mother OR [ ] Father OR [ ] State in this proceeding. [ ] I have requested an order for current/past support and have attached a Parent's Worksheet for child support. I calculated the gross income of the defaulting parent by [ ] The facts supporting my request(s) for relief in the sworn Petition filed (date) are incorporated into and made a part of this Motion and Affidavit. [ ] The summons was served on the other party who failed to comply with court-ordered genetic testing. OATH AND VERIFICATION I have read this Motion and Affidavit for Default Decree Without a Hearing and to the best of my knowledge everything I have said is true. I understand that if the judicial officer finds that I did file this Petition/Motion for an improper purpose, contempt or other sanctions may be ordered against me, including assessing me for any and all reasonable costs, attorney fees, or other expenses associated with the improper filing. Therefore, I ask this Court to sign the Decree/Judgment/Order submitted along with this Motion and Affidavit. DATE SIGNED SUSCRIBED AND SWORN to before me this 20 , by day of , My commission expires: Notary Public Superior Court of Arizona in Yavapai County January 2006 Page 2 of 2 CV62f American LegalNet, Inc. www.FormsWorkFlow.com