100-00262 Motion for Default Judgment and Affidavit (04/2015) Page 1 of 1
Docket No.: __________________________
MOTION FOR DEFAULT JUDGMENT
And Affidavit
1. Plaintiff moves for Default Judgment because defendant has failed to file an answer after being served.
2. I am ☐ Plaintiff ☐ Employee/Officer of the Plaintiff and my Title is (if applicable) ______________.
I state, under oath, that on information and belief the defendant is at least 18 years old and is not mentally
incompetent.
3. I state, under oath, that on information and belief the defendant is not a person in military service.
I know this because:
☐ a. ____________________________________________________________________________
OR
☐ b. Diligent search of Department of Defense database found at:
https://www.dmdc.osd.mil/appj/scra/scraHome.do. Proof of search attached.
4. I further state, under oath, that defendant owes plaintiff $____________ in damages.
The total amount I am seeking is:
Damages: $ _________________
Prejudgment interest: $ _________________
Filing fees: $ _________________
Service costs: $ _________________
TOTAL: $ _________________
Dated at _____________________________ this __________ day of ____________________, 20_____
_______________________________________
Signature of Plaintiff
Subscribed and sworn to this ________day of ________________, 20____,
Before me _____________________________
Notary Public