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vs. MOTION FOR DEFAULT JUDGMENT And Affidavit (Small (Vermont Judiciary)

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100-00262 Motion for Default Judgment and Affidavit (06/2020) Page 1 of 2
STATE OF VERMONT
SUPERIOR COURT
CIVIL DIVISION
Unit
Docket No.:
Plaintiff(s)
vs.
Defendant(s)
MOTION FOR DEFAULT JUDGMENT
And Affidavit
(Small Claims Case)
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: $ _________________
5. The reason the Defendant owes this money is (please set forth a complete, detailed explanation of why the
Defendant owes you the damages claim in paragraph 4 above):
_______________________________________________________________________________________
_______________________________________________________________________________________
_______________________________________________________________________________________
100-00262 Motion for Default Judgment and Affidavit (06/2020) Page 2 of 2
6. The following documents support this claim (please identify and provide copies of any contract, invoice,
receipt, estimate, or other document that details or support your claimed damages):
_______________________________________________________________________________________
_______________________________________________________________________________________
_______________________________________________________________________________________
Dated at _____________________________ this __________ day of ____________________, 20__________
_______________________________________
Signature of Plaintiff
Subscribed and sworn to this __________ day of ____________________, 20__________,
Before me _________________________________________
Notary Public
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vs. MOTION FOR DEFAULT JUDGMENT And Affidavit (Small (Vermont Judiciary)

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Completed 30 July 2020

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