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This is a Arizona form that can be used for Fee Waiver And Deferral within Statewide.
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(COURT'S JURISDICTIONAL NAME AND ADDRESS HERE) Case Number: Name of Petitioner/Plaintiff ORDER REGARDING DEFERRAL OF SERVICE OF PROCESS FEE FOR INJUNCTIONS AGAINST HARASSMENT Name of Respondent/ Defendant UPON VERBAL AVOWAL OR WRITTEN APPLICATION AND A FINDING OF GOOD CAUSE, IT IS ORDERED: (Check all boxes that apply) [ ] DEFERRAL IS GRANTED for the service of process fee. The applicant shall make payments as set forth below. [ ] DEFERRAL IS DENIED for the service of process fee. The applicant does not meet the financial criteria for deferral. DATED: [ ] Judicial Officer PAYMENT DUE DATE The applicant shall pay the service of process fee of $ on or before (date) . [ ] Special Commissioner If payment is not made in full when due, you will receive a notice reminding you that you may submit a supplemental application for further deferral or waiver if you believe you still cannot afford to pay your court fees and/or costs. The court will decide at that time whether or not you must pay. NOTE: IF THE APPLICATION IS BY VERBAL AVOWAL, THE APPLICANT MUST SIGN THE CONSENT ON THE NEXT PAGE. If payment of the service of process fee has been postponed and payment is not made in full when due, you will receive a Notice of Court Fees and Costs Due reminding you that you may submit a supplemental application for further deferral or waiver if you believe you still cannot afford to pay your court fees. The court will decide at that time whether or not you must pay. CONSENT TO ENTRY OF JUDGMENT. By signing this section, I agree that a judgment may be entered against me for all fees that are deferred, but that remain unpaid thirty (30) calendar days after the entry of final judgment. Judgment may be entered against me unless any of the following applies: A. Fees and costs are taxed to another party; B. I have an established schedule of payments in effect and I am current with those payments; C. I filed a supplemental application for waiver or further deferral of fees and costs and a decision by the court is pending; D. In response to a supplemental application, the court orders that the fees and costs be waived or further deferred; or, Revised September 2014 Page 1 of 2 AOC DVPO17F American LegalNet, Inc. www.FormsWorkFlow.com E. Within twenty (20) days of the date the court denies the supplemental application, I either: 1. Pay the fees and costs; or, 2. Request a hearing on the court's order denying further deferral or waiver. If I request a hearing, the court cannot enter the consent judgment unless a hearing is held, further deferral or waiver is denied, and payment has not been made within the time prescribed by the court. ACKNOWLEDGMENT AND SIGNATURE UNDER OATH Date: Signature Applicant's Printed Name SUBSCRIBED AND SWORN or affirmed and acknowledged before me on this ____ day of ________________, 20____. By . My Commission Expires/Seal: Judicial Officer, Deputy Clerk or Notary Public Revised September 2014 Page 2 of 2 AOC DVPO17F American LegalNet, Inc. www.FormsWorkFlow.com