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Sample Application for Default Judgment – Personal Service

{City}, {State} {ZIP}
{Facsimile: }

{Lawyer Name (Bar No.)}
Email: {}

Attorney for Plaintiff

In the Superior Court of the state of Arizona
In and for the County of Maricopa

[Insurance Company of At-Fault Driver],



[Individuals and Entities Including Lienholders Who May Have A Right to Policy Limit Proceeds],


Case No.: ____________________________



(Hon. [Assigned Judge’s Name])



Plaintiff, by and through undersigned counsel, requests that the Clerk of this Court enter the default of Defendant [], pursuant to Rule 55 of the Arizona Rules of Civil Procedure (“Ariz. R. Civ. P.”) for the reason that Defendant [] has failed to plead or otherwise defend this action as required by Rule 12 of the Ariz. R. Civ. P.

Plaintiff served Defendant [] with the Complaint, Summons, and Notice via personal service on [] on [] by personally leaving copies with [Defendant or Name of Eligible Household Member to Accept Service]. Defendant [] has not filed an Answer to the Complaint as of [], as required by Rule 12(a)(1)(A)(i) of the Arizona Rules of Civil Procedure. This Application for Entry of Default is supported by the accompanying Affidavit of Default.

In compliance with the provisions of Ariz. R. Civ. P. 55(a)(1), Plaintiff has mailed a copy of this Application and accompanying Affidavit in Support of Entry of Default to Defendant [] at the following known address:

{Defendant’s name}
{City} {Arizona}, {Zip}

If Defendant fails to file a responsive pleading or otherwise defend this action within ten (10) days of the filing of this Application, a default judgment will be requested in favor of the Plaintiff.

In light of the foregoing, Plaintiff respectfully requests that at the expiration of ten (10) days following the filing of this Application, the Court enter Judgment by default in favor of Plaintiff, including an award of Plaintiff’s costs and attorney’s fees associated with prosecuting this matter.

DATED this ____ day of _____________, _____.




Respectfully submitted,

{law firm name}



{Law Firm Address}

{City} {Arizona}, {Zip}

Attorney for Plaintiff



ORIGINAL of the foregoing e-filed

this ____day of ____________. 20__.


COPY of the foregoing mailed this

this ____day of ____________. 20__, to:


{Counsel of Record}
{Firm Name]
{City] [Arizona], [Zip]


{Name of Defendant}{Pro se}
{City} {Arizona}, {Zip]





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Disclaimer: The information and forms on this site are for illustrative purposes only. The information is not intended to be used by anyone other than a licensed Arizona attorney familiar with Arizona personal injury law. The forms and the information contained in them may not be up-to-date and must be independently reviewed, cite checked, rule checked, and otherwise verified by a licensed Arizona attorney. The information contained in the forms on this website cannot and must be relied on for the purposes of filing legal documents or otherwise pursuing a claim. If you have any questions about this, please contract and attorney at or by calling 602-833-1274.