Stipulation To Mediate Legal Decision Making

Name: ___________________________________ Address: _________________________________ City, State, ZIP: ____________________________ Daytime Telephone No: ______________________ Representing Self, Without a Lawyer ARIZONA SUPERIOR COURT, PIMA COUNTY _____________________________________________ Petitioner/Plaintiff and Case No. _________________ ACCEPTANCE OF SERVICE _____________________________________________ Respondent/Defendant THE RESPONDENT IN THIS ACTION MAKES THESE STATEMENTS UNDER OATH: 1. I acknowledge and that I have voluntarily accepted a copy of these legal papers: Summons; Petition for Dissolution; and other documents (if applicable, list them here): ______________________________________________________________________________________ ______________________________________________________________________________________ ______________________________________________________________________________________ I waive formal service of process (personal service), and understand by accepting these papers, it is the same as if I were personally served under Arizona Law [Arizona Rule of Civil Procedure 4 (f)]; 2. I am aware that my taking service of these court papers and signing this document does not in any way reduce my rights or obligation to file a written Response to this action. I understand that if I do not agree with any relief asked by Petitioner, I must Respond within 20 days if I accepted service in Arizona, or 30 days if I was served elsewhere, counting from the day after I signed this form; 3. I understand that if I do not appear and defend in this action in Court, within the time allowed by law, that I may lose my right to be heard in this case. I understand that failure to respond or appear could result in the Court giving the Petitioner any and all things requested in his or her Petition, through a Default Judgment; 4. I am not in the military forces of the United States of America in any capacity, or I waive the protection of the Service Members Civil Relief Act, and, 1 dissolution-acceptance of service.form Revised 08.05.04 American LegalNet, Inc. www.USCourtForms.com 5. (COMPLETE THIS PART ONLY IF YOU WANT TO RESTORE YOUR NAME TO WHAT IT WAS BEFORE THE MARRIAGE) My spouse or I took the name of the other spouse at the time of marriage and my spouse or I want to restore my name to the name used before the marriage. Please restore the name from to . ____________________________________ Respondent SUBSCRIBED AND SWORN to before me this . day of ______________________________, 20________, by ____________________________________ Notary Public My Commission Expires: ______________________ 2 dissolution-acceptance of service.form Revised 08.05.04 American LegalNet, Inc. www.USCourtForms.com