PIMA COUNTY CONSOLIDATED JUSTICE COURT_ 115 NORTH CHURCH AVE

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					                            PIMA COUNTY CONSOLIDATED JUSTICE COURT
              115 NORTH CHURCH AVENUE, TUCSON, AZ 85701-1130 (520)740-3171/TTY#(520)740-3019

 PLAINTIFF                                                   CASE NO.                    DEFENDANT

                                                ___________________________

 (Name/Address/Phone):                         REQUEST/JUDGMENT                          (Name/Address/Phone):

  REQUEST TO THE CLERK:
  PLEASE ENTER:
  □        Enter dismissal:          □   with prejudice
                                     □   without prejudice
  □        Writ of Execution
  □        Issue subpoena(s) - Number
  □        Issue transcript
  □        Writ of Restitution
  □        Satisfaction of Judgment
  □        Certified copy of Judgment
  □        Other:

  Signature___________________________________                    Signature __________________________________
  □     Plaintiff      □   Authorized Agent Signature             □     Defendant        □     Authorized Agent Signature

  ISSUED this date:
                                                                  Clerk
  TO THE JUSTICE OF THE PEACE:
  PLEASE ENTER JUDGMENT:
  □        Default
  □        Principle                                              $ __________________

           Court Costs                                            $ __________________

           Attorney Fees                                          $ __________________

          Accrued Interest                                        $ __________________

          Other                                                   $ __________________         Total $ _________________

  With interest at the rate of 10% per annum from the date of judgment until paid in full, plus accruing costs.

  IT IS SO ORDERED this date:
                                                                      Justice of the Peace

  Copy of the foregoing mailed this date:
  to:     □    Plaintiff    □      Defendant   □   Runner Service _____________________________________

  Clerk:________________________


JP18 (Rev. 06-01-09)/ec/mt/an/mm                                          White-Court   Yellow-Plaintiff   Pink-Defendant