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SUPERIOR COURT OF ARIZONA (Maricopa County Telecommunications)

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© Superior Court of Arizona in Maricopa County CVC61f - 041019
ALL RIGHTS RESERVED Page 1 of 5
Person Filing:
Address (if not protected):
City, State, Zip Code:
Telephone:
Email Address:
Lawyer’s Bar Number:
Representing Self, without a Lawyer or Attorney for Petitioner OR Respondent
SUPERIOR COURT OF ARIZONA
IN MARICOPA COUNTY
Case Number:
Name of Plaintiff
APPLICATION and AFFIDAVIT
For DEFAULT
(Civil Cases Only)
Name of Defendant
NOTICE: This is an important Court Document. Properly complete and file this Application and
Affidavit. Filing of this Application constitutes “Entry” of Default. The Default is effective ten (10) working
days after you file this completed Application, unless the Defendant files an Answer/Response or
otherwise defends before the ten working day period expires.
APPLICATION FACTS:
1. IDENTIFICATION of PARTIES:
I am the Plaintiff in this court case. I understand and make the following statements under oath or
by affirmation. I give notice that I am applying for default against the other party, the Defendant,
because the Defendant has not filed an Answer/Response.
I am seeking a default against, Defendant, , in this
case. (name of defendant)
(Check all that apply)
For Clerk’s Use Only
Case No. _____________________
© Superior Court of Arizona in Maricopa County CVC61f - 041019
ALL RIGHTS RESERVED Page 2 of 5
Defendant has not filed an Answer/Response, and has failed to appear, or defend within the
time allowed by A.R.C.P Rule 55.
Defendant is 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 “Soldiers and Sailor’s Civil
Relief Act”).
Defendant is not a minor and is not incompetent.
Defendant’s current mailing address is:
I do not know Defendant’s current address, or the Defendant’s whereabouts.
2. IDENTIFICATION of PARTIES’ ATTORNEYS:
(Check One)
I have no attorney.
I am represented by an attorney whose name and address is:
(Check One)
Defendant is not represented by an attorney that I know of.
Defendant is represented by an attorney whose name and address is:
I do not know the identity and address of the attorney known to represent the Defendant in this
action or a related action.
3. PROOF OF SERVICE: I served Defendant as follows:
(Check One)
Defendant signed an “Acceptance of Service” form, and accepted service of the “Summons,”
“Complaint,” and other papers.
I attached the “Acceptance of Service” form to this Application as proof of service.
Case No. _____________________
© Superior Court of Arizona in Maricopa County CVC61f - 041019
ALL RIGHTS RESERVED Page 3 of 5
Defendant signed a “Waiver of Service” form, and waived service of the “Summons,”
“Complaint,” and other papers.
I attached the “Waiver of Service” form to this Application as proof of service.
I served the Defendant by process server, alternative service, or by publication, with the
“Summons,” “Complaint,” and other papers.
I attached the proof of service to this Application.
4. NOTICE:
(Check all that apply)
To the Defendant
I know the Defendant’s address, and mailed a copy of the “Application and Affidavit for
Default” to his/her last known address giving NOTICE of default; even if the Defendant is
represented by an attorney who has entered an appearance in this action.
I have not mailed a copy of this “Application and Affidavit” to the Defendant because I do not
know Defendant’s address or whereabouts, and I do not believe the Defendant is represented
by an attorney. (You can only check this box, if you served the Defendant by publication.)
To the Attorney of the Defendant: I mailed a copy of the “Application and Affidavit” to
Defendant’s attorney, giving NOTICE of Default whether or not the attorney has formally appeared
in this action.
To Other Parties (If applicable): I mailed a copy of the “Application and Affidavit” to all other
parties who have appeared in this action, which gives the parties NOTICE of default.
Time of Notice: I mailed a copy of this “Application and Affidavit” to the Defendant on the date
that I filed this Application, or as soon as practicable after its filing, thus giving NOTICE. Please see
the Affidavit and Certificate of Mailing or Delivery at the bottom of this form.
APPLICATION REQUEST:
1. I file this Application and Affidavit to give notice to all parties in this action, and the Court, that I am
beginning default proceedings against the named Defendant, who has failed to answer, plead, or otherwise
defend this action.
Case No. _____________________
© Superior Court of Arizona in Maricopa County CVC61f - 041019
ALL RIGHTS RESERVED Page 4 of 5
2. With this document, I apply for Entry of Default. I understand my filing of this document at the Office of the
Clerk of the Superior Court constitutes “Entry of Default.”
AFFIDAVIT:
I, _________________________________, the Plaintiff in this action, hereby swear or affirm that:
__________________________________ is the Defendant in this action.
I served the Summons, Complaint, and other court documents to the above-named Defendant according to
law.
Defendant is the party against whom I seek a judgment for affirmative relief.
Defendant has failed to answer, plead or otherwise defend in this action.
I filed this Application and Affidavit for Default on ______________ (date) which constitutes the official Entry
of Default.
Date
Petitioner’s Signature
Printed Name
STATE OF
COUNTY OF
Subscribed and sworn to or affirmed before me this: by
(date)
.
(notary seal) Deputy Clerk or Notary Public
Case No. _____________________
© Superior Court of Arizona in Maricopa County CVC61f - 041019
ALL RIGHTS RESERVED Page 5 of 5
CERTIFICATE OF MAILING: On (date) 20_____, a copy of this
Application and Affidavit for Default was mailed, postage-prepaid, to the Defendant at:
current address (as listed below),
(address, city, state)
OR (if current address is unknown)
his/her last known address, as listed below:
(address, city, state)
IF I know the Defendant, who I claim to be in default, is represented by an attorney, I have also mailed
a copy of this Application and Affidavit to that attorney.
___________________________________________________________________________________
Name of Attorney
(address, city, state)
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SUPERIOR COURT OF ARIZONA (Maricopa County Telecommunications)

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Completed 28 March 2022

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