Arizona Supreme Court Page 1 of 2 AOC DFGF12F-050119 (COURT222S JURISDICTIONAL NAME AND ADDRESS HERE) Name of Petitioner/Plaintiff Name of Respondent/Defendant Case Number: REQUEST AND ORDER FOR HEARING Check at least one of the following: [ ] I request a hearing on the denial of my supplemental application for waiver or further deferral. [ ] I do not agree with the amount of unpaid fees and costs on the itemized statement provided by the court. I request a hearing on the calculation of the unpaid fees and costs. Date: Signature Applicant222s Printed Name The Court completes the following section. American LegalNet, Inc. www.FormsWorkFlow.com Case Number: Arizona Supreme Court Page 2 of 2 AOC DFGF12F-050119 IT IS ORDERED scheduling a hearing on the above matter. Hearing Date: Hearing Time: Hearing Location: Hearing Officer: DATED: [ ] Judicial Officer [ ] Special Commissioner I CERTIFY that I mailed/delivered a copy of this document to: [ ] Applicant [ ] at the above address [ ] in court [ ] Applicant222s attorney [ ] at the above address [ ] in court Date: By Clerk American LegalNet, Inc. www.FormsWorkFlow.com