Arizona > Local County > Maricopa > Superior Court > Juvenile
Application For Deferral Of Court Fees And Or Costs And Consent To Entry Of Judgment JGW11f - Arizona
| Application For Deferral Of Court Fees And Or Costs And Consent To Entry Of Judgment Form. This is a Arizona form and can be used in Juvenile Superior Court Maricopa Local County . |
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Name of Person Filing Document: Your Address: Your City, State, and Zip Code: Your Telephone Number: Attorney Bar Number (if applicable): Representing Self or Attorney for SUPERIOR COURT OF ARIZONA MARICOPA COUNTY Case Number: Name of Petitioner APPLICATION FOR DEFERRAL OF COURT FEES AND/OR COSTS AND Name of Respondent CONSENT TO ENTRY OF JUDGMENT STATE OF ARIZONA ) ss COUNTY OF ) STATEMENTS MADE TO THE COURT UNDER OATH OR AFFIRMATION. I swear or affirm that the information in this application is true and correct. I make this statement on behalf of the estate under the penalty of prosecution for perjury if it is determined that I did not te ll the truth. 1. I am requesting a deferral of the following fees and/or costs in my case: Any or all of the following: All filing fees, fees for the issuance of summonses and subpoenas, fees for obtaining one certified copy of a temporary order in a domestic relations case, a final order, judgment or decree in all civil proceedings, child support payment histo ry and fees for attending the Domestic Relations Education on Ch ildrens Issues Program, pursuant to A.R.S. 25-355. Fees for service of process by a sheriff, marshal, constable or local law enforcement agency (fill out separate affidavit form). Fees for service by publication (fill out separate affidavit form). Filing fees and photocopy fees for the preparation of the record on appe al. Court reporters fees of reporters or transcribers employed by the court for the preparation of the transcript. Court accountant fees and costs Court investigator fees and costs 2. My interest in this case is (check on box): Petitioner for Appointment of a Guardian of a Minor Other (describe): Superior Court of Arizona in Maricopa County JGW11f November 4, 2004 Page 1 of 5 Use current form ALL RIGHTS RESERVED APD <<<<<<<<<********>>>>>>>>>>>>> 23. The basis for the deferral request is that I or the Estate/Ward/Protected Person receive governmental assistance from the state/federal program(s) checked below: Temporary Assistance to Needy Families (TANF) Food Stamps Supplemental Security Income (SSI) General Assistance (GA) IF YOU CHECKED ONE OF THE BOXES ABOVE, go directly to the end of the last page and date and or a notarysign the Application in front of the clerk public. You do not need to complete other parts of this form. OR 4. The basis for the deferral request is: A. My or the Estate/Ward/Protected Persons income is insufficient or is barely sufficient to meet the daily essentials of life, and includes no allotment that cou ld be budgeted for the fees and costs that are required to gain access to the court. You must fill out the Financial Questionnaire below. To determine whether income is insufficient or barely sufficient, the court will review your income and expenses. Among the factors the court may consider are: 1. Whether your gross income as computed on a monthly basis is 150% or less of the current federal poverty level. (To see if you qualify, a table showing 150% of the poverty levels by family size is attached.) Gross monthly income includes your share of community property income if available to you. 2. If your income exceeds 150% of the poverty level, but you have proof of extraordinary expenses, including medical expenses, costs of care for el derly or disabled family members or other expenses that the court finds are extraordinary and that reduce your gross monthly income to at or below 150% of the pov erty level. OR IF NONE OF THE ABOVE REASONS APPLY, you still may request a deferral of court fees and/or costs for good cause shown. If granted, the court either will postpone payment until the conclusion of the case or establish a schedule for you to make payments. B. I or the Estate/Ward/Protected Person do not have the money to pay court filing fees and/or costs now. I can pay the filing fees and/or costs at a later da te. Explain. You must fill out the following Financial Questionnaire. Superior Court of Arizona in Maricopa County JGW11f November 4, 2004 Page 2 of 5 Use current form ALL RIGHTS RESERVED APD <<<<<<<<<********>>>>>>>>>>>>> 3 FINANCIAL QUESTIONNAIRE Case Number JG SUPPORT RESPONSIBILITIES: List the individuals who you support (including paying child support and/or spousal maintenance): NAME RELATIONSHIP STATEMENT OF INCOME AND EXPENSES ASSISTANCE: I receive assistance from: Arizona Health Care Cost Containment System (AHCCCS) Arizona Long Term Care System (ALTCS) Other (explain): MONTHLY INCOME: My monthly income is: Employer name: Employer address: Employed since (month/year): Monthly gross income: $ Other current monthly income, including spousal maintenance, retirement, rental, interest, pensions, scholarships, grants, royalties, lottery winnings (explain amount and source): $ My spouses monthly gross income (if available to me): $ TOTAL MONTHLY INCOME:$ MONTHLY EXPENSES AND DEBTS: My monthly expenses and debts are: PAYMENT AMOUNT LOAN BALANCE Rent/Mortgage payment $ $ Car Payment $ $ Credit Card Payments $ $ Explain: Other payments & debts $ $ Explain: Superior Court of Arizona in Maricopa County JGW11f November 4, 2004 Page 3 of 5 Use current form ALL RIGHTS RESERVED APD <<<<<<<<<********>>>>>>>>>>>>> 4 MONTHLY EXPENSES AND DEBTS - continued Food/Household supplies $ Utilities/Telephone $ Clothing $ Medical/Dental/Drugs $ Health Insurance $ Nursing care $ Laundry $ Child Support $ Child Care $ Spousal Maintenance $ Car Insurance $ Gasoline/Bus Fare $ Contributions to Employer or Other Retirement Account $ TOTAL MONTHLY PAYMENTS$ STATEMENT OF ASSETS : Equity is defined as market value minus any liens or loans. List only those assets available to you and accessible without financial penalty. ESTIMATED VALUE Cash and Bank Accounts $ Credit Union Accounts $ Equity in: 1. Home $ 2. Other property $ 3. Cars/other vehicles $ Other, including stocks, bonds, etc. $ Retirement Accounts $ TOTAL ASSETS: $ EXTRAORDINARY EXPENSES: Other facts that support this application are: (For example, describe and provide proof of unusual medical needs, financial hardship, costs of care of elderly or disabled family members) DESCRIPTION AMOUNT $ $ $ TOTAL EXTRAORDINARY EXPENSES $ Superior Court of Arizona in Maricopa County JGW11f November 4, 2004 Page 4 of 5 Use current form ALL RIGHTS RESERVED APD <<<<<<<<<********>>>>>>>>>>>>> 5 CONSENT TO JUDGMENT: By signing this Application, you agree that a judgment may be entered against you for all fe
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