Application For Deferral Or Waiver Of Service Of Process Fees For Injunctions Against Harassment And Consent To Entry Of Judgment Page 2

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OR
d.
It would be useless or dangerous for me to try to obtain voluntary acceptance of service of process.
Explain: ________________________________________________________________________________
CONSENT TO ENTRY OF JUDGMENT: By signing this application, I agree a judgment may be entered against me for all fees
and costs that are deferred but remain unpaid 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 (20) days of the date the court denies the supplemental application, I either:
1. Pay 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.
If you appeal the final decision in your case a consent judgment for deferred fees and costs that remain unpaid in the lower court shall
not entered until after the appeals process is concluded.
ACKNOWLEDGEMENT AND SIGNATURE UNDER OATH
Today’s Date: ____________________
Signature: __________________________________________
Print Your Name: ____________________________________
SUBSCRIBED AND SWORN or affirmed and acknowledged before me on (date) _________________________________
By ____________________________.
____________________________________________
My Commission expires:
Judicial Officer, Clerk or Notary Public
Page 2 of 2
11-0118
Revised: 08/08/2008

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