COMMONWEALTH OF MASSACHUSETTS
COUNTY OF
THE SUPERIOR COURT
VS.
Plaintiff(s)
Defendant(s)
Civil Action No.
Print name:
Address:
Address:
Signature:
City/State/Zip
Phone Number
Dated
REQUEST FOR DEFAULT
(Pursuant to Mass.R.Civ.P. 55(a))
I, the undersigned attorney, for the above named Plaintiff
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 make application that the Defendant(s)
be defaulted.
SIGNED UNDER THE PENALTIES OF PERJURY