This is Valeria "Munique" Tachiquin

"This is Valeria "Munique" Tachiquin, an American citizen and young mother of five children who was shot and killed by a U.S. Border Patrol agent on September 28 in a suburb of San Diego several miles north of California’s border with Mexico. Valeria is one of an increasing number of fatalities who have been killed at the hands these agents — which has prompted an investigation by the Department of Homeland Security. In an emotional interview, Democracy Now! speaks with her father who says he still knows little about the circumstances of his daughter’s death. Watch the interview: http://youtu.be/18hoKrrNW3k. We also speak with Christian Ramirez, Director of Southern Border Communities Coalition, who was at the scene soon after the shooting." Published on 25 Oct 2012 by democracynow Visit http://www.democracynow.org for the complete transcript, additional reports on this topic, and more information. Watch the independent, global news hour live weekdays 8-9am ET. In the wake of a dramatic increase in deaths at the hands of U.S border patrol agents, the Department of Homeland Security has agreed to launch a long-awaited investigation into the agency's use of force. Since 2010, border agents have killed at least 18 people, including Valeria "Munique" Tachiquin, slain by a Border Patrol agent on September 28 in broad daylight several miles north of California's border with Mexico. Tachiquin was a U.S. citizen and mother of five children. Her family is now brings a wrongful death lawsuit against the Border Patrol. We're joined by Valeria's father, Valentin Tachiquin, and by Christian Ramirez, Director of Southern Border Communities Coalition and Human Rights Director of Alliance San Diego. Tune in to Democracy Now! for our upcoming Election Night broadcast on November 6:http://www.democracynow.org/blog/2012/10/10/expanding_the_debate_upcoming_dem... To watch the entire weekday independent news hour, read the transcript, download the podcast, search our vast archive, or to find more information about Democracy Now! and Amy Goodman, visithttp://www.democracynow.org. FOLLOW DEMOCRACY NOW! ONLINE: Facebook: http://www.facebook.com/democracynow Twitter: @democracynow Subscribe on YouTube: http://www.youtube.com/democracynow Listen on SoundCloud: http://www.soundcloud.com/democracynow ; Daily Email News Digest: http://www.democracynow.org/subscribe Please consider supporting independent media by making a donation to Democracy Now! today, Thank you Welcome To MY World For This Information.... Welcome to my world http://irishgreeneyes-welcometomyworld.blogspot.com/

AFFIDAVIT IN SUPPORT OF APPLICATION FOR DEFERRAL OR WAIVER OF SERVICE OF PROCESS COSTS Name of Respondent/Defendant

(COURT’S JURISDICTIONAL NAME AND ADDRESS HERE)

  Case Number:
Name of Petitioner/Plaintiff
AFFIDAVIT IN SUPPORT OF    
APPLICATION FOR DEFERRAL OR
WAIVER OF SERVICE OF PROCESS COSTS
Name of Respondent/Defendant

STATE OF ARIZONA         )
COUNTY OF ) 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 the penalty of prosecution for perjury if it is determined that I did not tell the truth.

I have requested a deferral or waiver of the following fees in my case:

[  ] Fees for service of process by a sheriff, marshal, constable, or law enforcement agency:  In support of my request, I state that (check and complete any that apply):
[  ] I have attempted to obtain voluntary acceptance of service of process without success on the person to be served.
[  ] It would be useless or dangerous for me to try to obtain voluntary acceptance of service by the person to be served because (explain):


[  ] An enforceable injunction against harassment has been granted to me against the person to be served.

[  ] Fees for publication: In support of my request, I state that I have attempted to locate the person to be served but I have been unable to locate that person (check and complete any that apply):
[  ] This is what I did to try to find the other party (explain):


[  ] I have contacted the person(s) listed below to try to find the location of the other party.
NAME      ADDRESS



SIGNATURE UNDER PENALTY OF PERJURY


Today’s Date: Signature:                                                
Print Your Name:                                                                  
INFORMATION FOR SERVICE

You must provide the following information:

To the best of my knowledge, as of (date)                                                    , the last known address of the person to be served was:
(Street Address, City and State)

APPLICATION FOR DEFERRAL OR WAIVER OF SERVICE OF PROCESS FEES FOR INJUNCTIONS AGAINST HARASSMENT AND CONSENT TO ENTRY OF JUDGMENT

(COURT’S JURISDICTIONAL NAME AND ADDRESS HERE)

                                                        Case Number:  
Name of Petitioner/Plaintiff.
APPLICATION FOR DEFERRAL OR WAIVER OF SERVICE OF PROCESS FEES FOR INJUNCTIONS AGAINST HARASSMENT AND
CONSENT TO ENTRY OF JUDGMENT
                                                       
Name of Respondent/Defendant.

STATE OF ARIZONA         )
COUNTY OF ) ss.

IMPORTANT
This “Application for Deferral or Waiver of Court Fees and/or Costs” includes a “Consent to Entry of Judgment.”  By signing this Consent, you agree a judgment may be entered against you for all fees and costs that are deferred but remain unpaid thirty (30) calendar days after entry of final judgment.  At the conclusion of the case you will receive a Notice of Court Fees and Costs Due indicating how much is owed and what step 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 “Consent to Entry of Judgment” section of this application.

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 under the penalty of prosecution for perjury if it is determined that I did not tell the truth.

I am requesting a deferral/waiver of the fee for service of process by a sheriff, marshal, constable or law enforcement agency.


The basis for the request is:

1. [  ] DEFERRAL:

A. [  ] I receive governmental assistance from the state/federal program(s) marked below:
[  ] Temporary Assistance to Needy Families (TANF)
[  ] Food Stamps (Renamed Supplemental Nutrition Assistance Program or SNAP).

OR
B. [  ] My income is insufficient or is 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.

NOTE:  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.  Gross monthly income includes your share of community property income if available to you.
2. If your income is greater than 150% of the poverty level, but you have proof of extraordinary expenses (including medical expenses and costs of care for elderly or disabled family members) or other expenses that the court finds are extraordinary that reduce your gross monthly income to at or below 150% of the poverty level.
OR
C. [  ] 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.

2. [  ] WAIVER:

A. [  ] 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.
B. [  ] I receive government assistance from the federal program Supplemental Security Income (SSI).

NOTE: Every applicant, regardless of his or her financial circumstances, must complete the Financial Questionnaire (below). If you submit the Application and Financial Questionnaire in person, you MUST sign it in front of the court clerk; if you submit the form by mail or by a third party, you MUST sign it in front of a notary public. You must submit proof that you receive governmental assistance. If you submit the Application and Financial Questionnaire by mail or by a third party, please attach a copy of your proof of governmental assistance.

FINANCIAL QUESTIONNAIRE
SUPPORT RESPONSIBILITIES: List all persons you support (including those you pay child support and/or spousal maintenance/support for):
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:
Monthly gross income: $                    
Employer name:                                                                                                
Employer address:                                                                                          
  Employed since (month/year):                                                                        

Other current monthly income, including spousal
maintenance/support, 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 $

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 $                                 $
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: List only those assets available to you and accessible without financial penalty.     Equity is defined as market value minus any liens or loans.
ESTIMATED VALUE
Cash and Bank Accounts $
Credit Union Accounts $
Equity in:
1. Home $
2. Other property $
3. Cars/other vehicles $
4. Other, including stocks, bonds, etc. $
5. Retirement accounts $

TOTAL ASSETS                                                 $



EXTRAORDINARY EXPENSES: For example, unusual medical needs, financial hardship, costs of care of elderly or disabled family members.  (Proof must be submitted.)

DESCRIPTION AMOUNT
                                                                            $
                                                                            $
                                                                            $

TOTAL EXTRAORDINARY EXPENSES $


Note: If you receive a deferral and have unpaid fees at the end of your case you will receive a Notice of Court Fees and Costs Due.  This is to remind you that you may submit a supplemental application for further deferral or waiver if you believe you need more time to pay or cannot afford to pay your court fees and costs.  The court will decide at that time whether or not you must pay.  If you do not file a supplemental application, the original deferral order remains in effect and a consent judgment may be entered against you if you do not pay within thirty calendar days after entry of final judgment.

If your case is dismissed for any reason, the fees and costs are still due.


CONSENT TO ENTRY OF JUDGMENT:  By signing this Application, I agree that a judgment may be entered against me for all fees and/or costs that are deferred but remain unpaid after thirty (30) calendar days after entry of final judgment.  Judgment may be entered against me unless any one 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 file 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
E. Within twenty days of the date the court denies the supplemental application, I either:
1. Pay the fees and/or costs; or,
2. Request a hearing on the court’s order denying waiver or further deferral.  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.


OATH OR AFFIRMATION
The contents of this document are true and correct to the best of my knowledge and belief.
Date Signature
Printed Name
Date Signed or Affirmed Judicial Officer, Deputy Clerk or Notary Public
My Commision Expires/Seal:

ORDER REGARDING DEFERRAL OF SERVICE OF PROCESS FEES FOR INJUNCTIONS AGAINST HARASSMENT

(COURT’S JURISDICTIONAL NAME AND ADDRESS HERE)



Case Number:
Name of Petitioner/Plaintiff.
ORDER REGARDING DEFERRAL OF
SERVICE OF PROCESS FEES 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  [  ]  Special Commissioner

PAYMENT DUE DATE

The applicant shall pay the service of process fee of $                             on or before (date)                                  
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 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 one 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 file 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
E. Within twenty 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



Today’s Date: Signature:

Print Your Name:

SUBSCRIBED AND SWORN or affirmed and acknowledged before me on (date)

By                                      .



 
My Commision Expires/Seal: Judicial Officer, Clerk or Notary Public

CONSENT JUDGMENT

(COURT’S JURISDICTIONAL NAME AND ADDRESS HERE)


                                                      Case Number:                      
Name of Petitioner/Plaintiff.
CONSENT JUDGMENT
FOR COURT FEES AND COSTS
                                                         
Name of Respondent/Defendant.

An application for deferral of court fees and costs has been granted in this case.  Pursuant  to A.R.S. § 12-302(F), the applicant signed a consent to entry of judgment for court fees and costs not taxed to another party that remain unpaid for thirty calendar days following entry of final judgment.  MORE THAN thirty (30) days have elapsed since the entry of final judgment and  unpaid fees and costs exists which the applicant is responsible to pay.

[  ] The applicant has not filed a supplemental application for waiver or further deferral; OR,
[  ] The applicant has filed a supplemental application for waiver or further deferral which has been denied by the court, AND EITHER:

[  ] More than twenty (20) days have elapsed since the denial and the applicant has neither requested a hearing nor paid the unpaid fees and costs;
OR,
[  ] Within twenty (20) days the applicant has requested a hearing and, after hearing, the court has affirmed the denial and the applicant has failed to pay the fees and costs within the time prescribed by the court;
OR,
[  ] The applicant has filed a supplemental application.  Further deferral has been granted and the applicant failed to pay the amount due as ordered.

 JUDGMENT IS GRANTED in favor of this court and against (print applicant’s name here)                                                                    in the amount of $                          , representing the total amount of deferred court fees and costs remaining unpaid that the applicant is responsible to pay.



Dated:                                                                                                                   Judicial Officer

SUPPLEMENTAL APPLICATION FOR DEFERRAL OR WAIVER OF COURT FEES AND/OR COSTS

(COURT’S JURISDICTIONAL NAME AND ADDRESS HERE)


                            Case Number:  
Name of Petitioner/Plaintiff.
SUPPLEMENTAL APPLICATION FOR DEFERRAL OR WAIVER OF COURT FEES AND/OR COSTS
                                                     
Name of Respondent/Defendant.

STATE OF ARIZONA         )
COUNTY OF ) ss.


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 under the penalty of prosecution for perjury if it is determined that I did not tell the truth.

I am requesting a deferral/waiver of any unpaid fees and/or costs in my case.

The basis for the request is:

1. [  ] DEFERRAL:

A. [  ] I receive governmental assistance from the state/federal program(s) marked below:
[  ] Temporary Assistance to Needy Families (TANF) [  ] Food Stamps

OR
B. [  ] My income is insufficient or is 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.

NOTE:  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.  Gross monthly income includes your share of community property income if available to you.
2. If your income is greater than 150% of the poverty level, but you have proof of extraordinary expenses (including medical expenses and costs of care for elderly or disabled family members) or other expenses that the court finds are extraordinary that reduce your gross monthly income to at or below 150% of the poverty level.
OR
C. [  ] 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.

2. [  ] WAIVER:

A. [  ] 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.
B. [  ] I receive government assistance from the federal program Supplemental Security Income (SSI).



NOTE: Every applicant, regardless of his or her financial circumstances, must complete the Financial Questionnaire (below). If you submit the Application and Financial Questionnaire in person, you MUST sign it in front of the court clerk; if you submit the form by mail or by a third party, you MUST sign it in front of a notary public. You must submit proof that you receive governmental assistance. If you submit the Application and Financial Questionnaire by mail or by a third party, please attach a copy of your proof of governmental assistance.

FINANCIAL QUESTIONNAIRE
SUPPORT RESPONSIBILITIES: List all persons you support (including those you pay child support and/or spousal maintenance/support for):
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:
Monthly gross income: $                    
Employer name:                                                                                                
Employer address:                                                                                          
  Employed since (month/year):                                                                        

Other current monthly income, including spousal
maintenance/support, 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 $

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 $                                 $
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: List only those assets available to you and accessible without financial penalty.     Equity is defined as market value minus any liens or loans.
ESTIMATED VALUE
Cash and Bank Accounts $
Credit Union Accounts $
Equity in:
1. Home $
2. Other property $
3. Cars/other vehicles $
4. Other, including stocks, bonds, etc. $
5. Retirement accounts $

TOTAL ASSETS                                                 $


EXTRAORDINARY EXPENSES: For example, unusual medical needs, financial hardship, costs of care of elderly or disabled family members.  (Proof must be submitted.)

DESCRIPTION AMOUNT
                                                                            $
                                                                            $
                                                                            $

TOTAL EXTRAORDINARY EXPENSES $


OATH OR AFFIRMATION
The contents of this document are true and correct to the best of my knowledge and belief.
Date Signature
Printed Name
Date Signed or Affirmed Judicial Officer, Deputy Clerk or Notary Public
My Commision Expires/Seal:

NOTICE OF COURT FEES AND COSTS DUE

NOTICE OF COURT FEES AND COSTS DUE







When your case was filed, you requested that the court defer the court fees and costs in your case. The court granted you a deferral. A deferral means that payment was postponed and you did not have to pay all the costs and fees while your case was open. The case is now over.

Payment of court fees and costs in the amount of $                   are now due in your case. You must either pay these fees and costs or file a supplemental application for waiver or further deferral by (date)                                       .

If you do not pay or file a supplemental application by the above date, a judgment for the total amount of unpaid fees and costs will be entered against you.  The court may then take legal steps to collect the unpaid judgment.

You may make the payment or obtain and file a supplemental application at (court name, location and telephone number)
  .

In the supplemental application, if you qualify, you can ask the court for:
1. Waiver of fees and costs.  This means you never have to pay the fees and costs in this case.
2. Further deferral of fees and costs.  This means the court arranges a payment schedule.

You may also ask the court for an itemized statement of unpaid fees and costs at no cost
to you.  After reviewing the itemized statement, if you disagree with the amount owed the court, you may request a hearing. If you file a supplemental application for further deferral or waiver of the court fees and costs and the application is denied, you may request a hearing. Supplemental applications or forms to request a hearing are available online at: or
at   the following court locations:

ORDER REGARDING SERVICE OF PROCESS FEES FOR AN INJUNCTION AGAINST HARASSMENT

(COURT’S JURISDICTIONAL NAME AND ADDRESS HERE)


  Case Number:
Name of Plaintiff/Petitioner.
ORDER REGARDING SERVICE OF
PROCESS FEES FOR AN INJUNCTION AGAINST HARASSMENT

Name of Defendant/Respondent.


UPON VERBAL AVOWAL OR WRITTEN APPLICATION AND A FINDING OF GOOD CAUSE,

IT IS ORDERED:

[  ] WAIVER IS GRANTED for the service of process fee.

[  ] WAIVER IS DENIED for the service of process fee.  The applicant does not meet the financial criteria for waiver.





DATED:                                               _____________________________________
Judicial Officer

ORDER REGARDING DEFERRAL OF SERVICE OF PROCESS FEES FOR INJUNCTIONS AGAINST HARASSMENT

(COURT’S JURISDICTIONAL NAME AND ADDRESS HERE)



Case Number:
Name of Petitioner/Plaintiff.
ORDER REGARDING DEFERRAL OF
SERVICE OF PROCESS FEES 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  [  ]  Special Commissioner

PAYMENT DUE DATE

The applicant shall pay the service of process fee of $                             on or before (date)                                  
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 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 one 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 file 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
E. Within twenty 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



Today’s Date: Signature:

Print Your Name:

SUBSCRIBED AND SWORN or affirmed and acknowledged before me on (date)

By                                      .



 
My Commision Expires/Seal: Judicial Officer, Clerk or Notary Public

APPLICATION FOR DEFERRAL OR WAIVER OF SERVICE OF PROCESS FEES FOR INJUNCTIONS AGAINST HARASSMENT AND CONSENT TO ENTRY OF JUDGMENT

(COURT’S JURISDICTIONAL NAME AND ADDRESS HERE)

                                                        Case Number:  
Name of Petitioner/Plaintiff.
APPLICATION FOR DEFERRAL OR WAIVER OF SERVICE OF PROCESS FEES FOR INJUNCTIONS AGAINST HARASSMENT AND
CONSENT TO ENTRY OF JUDGMENT
                                                       
Name of Respondent/Defendant.

STATE OF ARIZONA         )
COUNTY OF ) ss.

IMPORTANT
This “Application for Deferral or Waiver of Court Fees and/or Costs” includes a “Consent to Entry of Judgment.”  By signing this Consent, you agree a judgment may be entered against you for all fees and costs that are deferred but remain unpaid thirty (30) calendar days after entry of final judgment.  At the conclusion of the case you will receive a Notice of Court Fees and Costs Due indicating how much is owed and what step 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 “Consent to Entry of Judgment” section of this application.

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 under the penalty of prosecution for perjury if it is determined that I did not tell the truth.

I am requesting a deferral/waiver of the fee for service of process by a sheriff, marshal, constable or law enforcement agency.


The basis for the request is:

1. [  ] DEFERRAL:

A. [  ] I receive governmental assistance from the state/federal program(s) marked below:
[  ] Temporary Assistance to Needy Families (TANF)
[  ] Food Stamps (Renamed Supplemental Nutrition Assistance Program or SNAP).

OR
B. [  ] My income is insufficient or is 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.

NOTE:  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.  Gross monthly income includes your share of community property income if available to you.
2. If your income is greater than 150% of the poverty level, but you have proof of extraordinary expenses (including medical expenses and costs of care for elderly or disabled family members) or other expenses that the court finds are extraordinary that reduce your gross monthly income to at or below 150% of the poverty level.
OR
C. [  ] 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.

2. [  ] WAIVER:

A. [  ] 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.
B. [  ] I receive government assistance from the federal program Supplemental Security Income (SSI).

NOTE: Every applicant, regardless of his or her financial circumstances, must complete the Financial Questionnaire (below). If you submit the Application and Financial Questionnaire in person, you MUST sign it in front of the court clerk; if you submit the form by mail or by a third party, you MUST sign it in front of a notary public. You must submit proof that you receive governmental assistance. If you submit the Application and Financial Questionnaire by mail or by a third party, please attach a copy of your proof of governmental assistance.

FINANCIAL QUESTIONNAIRE
SUPPORT RESPONSIBILITIES: List all persons you support (including those you pay child support and/or spousal maintenance/support for):
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:
Monthly gross income: $                    
Employer name:                                                                                                
Employer address:                                                                                          
  Employed since (month/year):                                                                        

Other current monthly income, including spousal
maintenance/support, 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 $

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 $                                 $
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: List only those assets available to you and accessible without financial penalty.     Equity is defined as market value minus any liens or loans.
ESTIMATED VALUE
Cash and Bank Accounts $
Credit Union Accounts $
Equity in:
1. Home $
2. Other property $
3. Cars/other vehicles $
4. Other, including stocks, bonds, etc. $
5. Retirement accounts $

TOTAL ASSETS                                                 $



EXTRAORDINARY EXPENSES: For example, unusual medical needs, financial hardship, costs of care of elderly or disabled family members.  (Proof must be submitted.)

DESCRIPTION AMOUNT
                                                                            $
                                                                            $
                                                                            $

TOTAL EXTRAORDINARY EXPENSES $


Note: If you receive a deferral and have unpaid fees at the end of your case you will receive a Notice of Court Fees and Costs Due.  This is to remind you that you may submit a supplemental application for further deferral or waiver if you believe you need more time to pay or cannot afford to pay your court fees and costs.  The court will decide at that time whether or not you must pay.  If you do not file a supplemental application, the original deferral order remains in effect and a consent judgment may be entered against you if you do not pay within thirty calendar days after entry of final judgment.

If your case is dismissed for any reason, the fees and costs are still due.


CONSENT TO ENTRY OF JUDGMENT:  By signing this Application, I agree that a judgment may be entered against me for all fees and/or costs that are deferred but remain unpaid after thirty (30) calendar days after entry of final judgment.  Judgment may be entered against me unless any one 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 file 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
E. Within twenty days of the date the court denies the supplemental application, I either:
1. Pay the fees and/or costs; or,
2. Request a hearing on the court’s order denying waiver or further deferral.  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.


OATH OR AFFIRMATION
The contents of this document are true and correct to the best of my knowledge and belief.
Date Signature
Printed Name
Date Signed or Affirmed Judicial Officer, Deputy Clerk or Notary Public
My Commision Expires/Seal:

AFFIDAVIT IN SUPPORT OF APPLICATION FOR DEFERRAL OR WAIVER OF SERVICE OF PROCESS COSTS Name of Respondent/Defendant form 3

(COURT’S JURISDICTIONAL NAME AND ADDRESS HERE)

  Case Number:
Name of Petitioner/Plaintiff
AFFIDAVIT IN SUPPORT OF    
APPLICATION FOR DEFERRAL OR
WAIVER OF SERVICE OF PROCESS COSTS
Name of Respondent/Defendant

STATE OF ARIZONA         )
COUNTY OF ) 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 the penalty of prosecution for perjury if it is determined that I did not tell the truth.

I have requested a deferral or waiver of the following fees in my case:

[  ] Fees for service of process by a sheriff, marshal, constable, or law enforcement agency:  In support of my request, I state that (check and complete any that apply):
[  ] I have attempted to obtain voluntary acceptance of service of process without success on the person to be served.
[  ] It would be useless or dangerous for me to try to obtain voluntary acceptance of service by the person to be served because (explain):


[  ] An enforceable injunction against harassment has been granted to me against the person to be served.

[  ] Fees for publication: In support of my request, I state that I have attempted to locate the person to be served but I have been unable to locate that person (check and complete any that apply):
[  ] This is what I did to try to find the other party (explain):


[  ] I have contacted the person(s) listed below to try to find the location of the other party.
NAME      ADDRESS



SIGNATURE UNDER PENALTY OF PERJURY


Today’s Date: Signature:                                                
Print Your Name:                                                                  
INFORMATION FOR SERVICE

You must provide the following information:

To the best of my knowledge, as of (date)                                                    , the last known address of the person to be served was:
(Street Address, City and State)

ORDER REGARDING DEFERRAL OR WAIVER OF COURT FEES AND COSTS AND NOTICE REGARDING CONSENT JUDGMENT

(COURT’S JURISDICTIONAL NAME AND ADDRESS HERE)

                                                                    Case Number:                                        
Name of Petitioner/Plaintiff.
ORDER REGARDING DEFERRAL OR WAIVER OF COURT FEES AND COSTS AND
                                                        NOTICE REGARDING CONSENT JUDGMENT
Name of Respondent/Defendant.



THE COURT FINDS that the applicant (print name):                                                                                           :

1. [  ] IS NOT ELIGIBLE FOR A DEFERRAL of fees and costs.
OR
2. [  ] IS ELIGIBLE FOR A DEFERRAL of fees and costs based on financial eligibility.  As required by state law, the applicant has signed a consent to entry of judgment.
OR
3. [  ] IS ELIGIBLE FOR DEFERRAL of fees and costs at the court’s discretion (A.R.S. § 12-302(L)).
OR
4. [  ] IS ELIGIBLE FOR DEFERRAL of fees and costs based on good cause shown.  As required by state law, the applicant has signed a consent to entry of judgment.
OR
5. [  ] IS ELIGIBLE FOR WAIVER of fees and costs because the applicant is permanently unable to pay.
OR
6. [  ] IS ELIGIBLE FOR WAIVER of fees and costs at the court’s discretion (A.R.S. § 12-302(L)).
OR
7. [  ] IS NOT ELIGIBLE FOR WAIVER of fees and costs.

IT IS ORDERED:

[  ] DEFERRAL DENIED for the following reason(s):
[  ] The application is incomplete because
You are encouraged to submit a complete application.
[  ] The applicant does not meet the financial criteria for deferral because
A deferral MUST BE granted if the applicant is receiving public assistance benefits from  the Temporary Assistance to Needy Families (TANF) program or  Food Stamps or has an income that is insufficient or barely sufficient to meet the daily essentials of life and that includes no allotment that could be budgeted to pay the fees and costs necessary to gain access to the court or if the applicant demonstrates other good cause.

[  ] DEFERRAL GRANTED for the following fees and costs in this court:
[  ] Any or all filing fees; fees for the issuance of either a summons and subpoena; or fees for obtaining one certified copy of a temporary order in a domestic relations case or a final order, judgment or decree in all civil proceedings.
[  ] Fees for service of process by a sheriff, marshal, constable or law enforcement agency.
[  ] Fees for service by publication.
[  ] Filing fees and photocopy fees for the preparation of the record on appeal.
[  ] Court reporter or transcriber fees if employed by the court for the preparation of the transcript.

IF A DEFERRAL IS GRANTED, PLEASE CHECK ONE OF THE FOLLOWING BOXES:
[  ] NO PAYMENTS WILL BE DUE UNTIL FURTHER NOTICE.
[  ] SCHEDULE OF PAYMENTS.
The applicant shall pay $                             each                             (week, month etc.) until paid in full, beginning                                                                                                                                  .

[  ] WAIVER DENIED for all fees and costs in this case.
[  ] WAIVER GRANTED for all fees and costs in this case that may be waived under A.R.S. §12-302(H).
[  ] Any or all filing fees; fees for the issuance of either a summons or subpoena; or fees for obtaining one certified copy of a temporary order in a domestic relations case or a final order, judgment or decree in all civil proceedings.
[  ] Fees for service of process by a sheriff, marshal, constable or law enforcement agency.
[  ] Fees for service by publication.
[  ] Filing fees and photocopy fees for the preparation of the record on appeal.
[  ] Court reporter or transcriber fees if employed by the court for the preparation of the transcript.

RIGHT TO JUDICIAL REVIEW. If the application is denied or a payment schedule set by a special commissioner, you may request the decision be reviewed by a judicial officer.  The request must be made within twenty (20) days of the day the order was mailed or delivered to you.  If a schedule of payments has been established, payments shall be suspended until a decision is made after judicial review.  Judicial review shall be held as soon as reasonably possible.

NOTICE REGARDING CONSENT JUDGMENT: Unless any one of the following applies, a consent judgment may be entered against the applicant for all fees and costs that are deferred and remain unpaid thirty (30) days after entry of final judgment:

A. Fees and costs are taxed to another party;
B. The applicant has an established schedule of payments in effect and is current with those payments;
C. The applicant  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
E. Within twenty days of the date the court denies the supplemental application, the applicant either:
1. Pays the fees and costs; or,
2. Requests a hearing on the court’s order denying further deferral or waiver. If the applicant requests 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.

If an appeal is taken, a consent judgment for deferred fees and costs that remain unpaid in the lower court shall not be entered until thirty (30) days after the appeals process is concluded.  The procedures for notice of court fees and costs and for entry of a consent judgment continue to apply.

If a consent judgment is signed and the applicant pays the fees and costs in full, the court is required to comply with the provisions of A.R.S. § 33-964(C).

DUTY TO REPORT CHANGE IN FINANCIAL CIRCUMSTANCES.  An applicant who is granted a deferral or waiver shall promptly notify the court of any change in financial circumstances during the pendency of the case that would affect the applicant’s ability to pay court fees and costs.   Any time the applicant appears before the court on this case, the court may inquire as to the applicant’s financial circumstances.

DATED:                                              
[  ] Judicial Officer [  ] Special Commissioner