Arizona > Local County > Pima > Superior Court > Family Law
Application For Deferral Of Court Fees And Or Costs And Consent To Entry Of Judgment - 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 Family Law Superior Court Pima Local County . |
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Name: ___________________________________ Address: _________________________________ City, State, ZIP: ____________________________ Daytime Telephone No: ______________________ Representing Self, Without a Lawyer ARIZONA SUPERIOR COURT, PIMA COUNTY ______________________________________ Petitioner and Case No. _________________ ______________________________________ Respondent APPLICATION FOR DEFERRAL OR WAIVER OF COURT FEES AND/OR COSTS AND CONSENT TO ENTRY OF JUDGMENT IMPORTANT: This Application for deferral of court fees and/or costs includes a Consent to Entry of Judgment. By signing this Consent, you agree that a judgment may be entered against you for all fees and/or costs that are deferred, but that remain unpaid after thirty (30) calendar days following the entry of final judgment. At the conclusion of the case you will receive a Notice indicating how much is owed and what steps you must take to avoid a judgment against you if you are still unable to pay. Additional details about this process are discussed in the Judgment Section of this Application. STATE OF ARIZONA COUNTY OF PIMA ) )ss ) STATEMENTS MADE TO THE COURT UNDER OATH. I swear or affirm that the information in this application is true and correct. I make this statement under penalty of prosecution for perjury if it is determined that I did not tell the truth. I am requesting a deferral or waiver of the following fees and/or costs in my case: Any or all of the following: All filing fees, fees for 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 history and fees for attending the Domestic Relations Education on Children's Issues Program, pursuant to A.R.S. ยง 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 preparation of the record on appeal. Court reporter's fees of reporters or transcribers employed by the court for the preparation of the transcript. 1 deferral-application for deferral/waiver consent to judgment.form Revised 02.11.11 American LegalNet, Inc. www.FormsWorkFlow.com The basis for this request is: WAIVER: I am permanently unable to pay My income and liquid assets are insufficient or barely sufficient to meet the daily essentials of life and unlikely to change in the foreseeable future. DEFERRAL: The basis for the deferral request is that I receive governmental assistance from the state/federal program(s) checked below: Temporary Assistance to Needy Families (TANF) Food Stamps (Qwest Card) Supplemental Security Income (SSI) for disabilities General Assistance (GA) IF YOU CHECKED ONE OF THE BOXES ABOVE (Wavier or Deferral), you must complete the Financial Questionnaire. You must sign this application in front of the court clerk or a notary public, if submitted by mail or a third party. You must also submit proof that you receive governmental assistance. If you are submitting this application by mail or a third party, you must attach a photocopy of that proof. OR The basis for the deferral or waiver request is: My income is insufficient or barely sufficient to meet the daily essentials of life, and includes no allotment that could 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 elderly or disabled family members or other expenses that the court finds are extraordinary and that reduce your gross monthly income to 150% of the poverty level or below. OR IF NONE OF THE ABOVE REASONS APPLY, you still may request a deferral or waiver 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. The basis for the deferral or waiver request is: I 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 date. Explain. ______________________________________________________________________________________ ______________________________________________________________________________________ ______________________________________________________________________________________ You must fill out the Financial Questionnaire (see next page). 2 deferral-application for deferral/waiver consent to judgment.form Revised 02.11.11 American LegalNet, Inc. www.FormsWorkFlow.com FINANCIAL QUESTIONNAIRE 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: Employer's name: __________________________________________________ Employer's 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 spouse's monthly gross income (if available to me): $____________ TOTAL MONTHLY INCOME: $___________ 3 deferral-application for deferral/waiver c
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