Commonwealth of Massachusetts

[Pages:1]SUFFOLK, ss.

Commonwealth of Massachusetts

TRIAL COURT OF THE COMMONWEALTH BOSTON MUNICIPAL COURT DEPARTMENT

Civil No.

Plaintiff(s) Defendant(s)

REQUEST FOR DEFAULT

(Pursuant to Rule 55 (a))

To the Clerk of the above-named Court:

I

, attorney for the above-named plaintiff(s),

state that the complaint in which a judgment for affirmative relief is

sought against the defendant(s)

herein, was filed on

and the summons and a copy of the complaint have been served on the defendant(s) herein

on

as appears from the officer's return; that the time within which the defendant(s) shall

serve a responsive pleading or otherwise defend pursuant to Rule 12(a), has expired and the defendant(s) herein

has/have failed to serve or file an answer or otherwise defend as to the complaint.

Wherefore, the plaintiff(s) defendant(s)

make(s) application that the be defaulted.

Dated at Boston, Massachusetts, this

day of

, 20

.

SIGNED UNDER THE PENALTIES OF PERJURY

Signed Print or Type Print or Type

Atty. for Plff Address

Tel. No. BBO No.

PLAINTIFF'S REQUEST FOR JUDGMENT FOR RELIEF

(Pursuant to Rule 55 (b)(1))

The undersigned requests that judgment enter against the defendant(s)

in the amount of $

together with interest in the sum of $

affidavit that:

with costs and make

1.

The total amount due the plaintiff(s), exclusive of costs in the claim against the defendant(s), is

$

0.00

.

2.

That the defendant(s) is/are not an infant or incompetent person.

3.

That the defendant(s) is/are not in the military service of the United States or its Allies, as defined

in the Servicemembers Civil Relief Act of 2003, as set forth in 50 U.S.C. App. ?? 501 et seq.,

evidenced by the following facts:

Subscribed this Execution requested.

day of

, 20

under the penalties of perjury.

P l a i n t i f f .

BMC-CV-005

REQUEST FOR DEFAULT AND DEFAULT JUDGMENT

(Rev. 06/10 swf)

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