Form CA 110-A: Application for Entry of Judgment and Notice to Defendant Superior Court of the District of Columbia CIVIL DIVISION 500 Indiana Avenue, N.W. Telephone: 879-1133 ____________________________________ vs. Plaintiff _________________________ Defendant Civil Action No. _______________________ APPLICATION FOR ENTRY OF JUDGMENT AND NOTICE TO DEFENDANT Plaintiff seeks entry of judgment in the above-entitled action and states: 1. On ____________________________ a Stipulation/settlement agreement was filed with the Court and entry of judgment against Defendant was stayed upon condition that Defendant pay $ ____________ per ____________ and/or perform the following actions: ________________________________________________________________________ ________________________________________________________________________ 2. To date Defendant has made the following payments and/or performed the following actions: _________________________________________________________________ ________________________________________________________________________ 3. On ____________________________, Defendant failed to satisfy the conditions of this stay by failing to __________________________________________________________ ________________________________________________________________________ For these reasons, the Clerk should enter judgment in the amount of $ _______________ plus interest and costs and/or require the following: ____________________________________ ______________________________________________________________________________ ____________________________________ (Signature) ____________________________________ (Address) ____________________________________ Telephone: __________________________ Form CV(6)-603/Feb. 2011 American LegalNet, Inc. www.FormsWorkFlow.com Form CA 110-A: Application for Entry of Judgment and Notice to Defendant CERTIFICATE OR OATH* I hereby certify/swear that the foregoing information is true and correct to the best of my knowledge and belief and that this application was mailed, by prepaid first-class mail, on ____________________________ to the above-designated defendant at ___________________ _____________________________________________________ and to the defendant's attorney at ____________________________________________________________________________ ____________________________________ Plaintiff or attorney for plaintiff ____________________________________ Address ____________________________________ Subscribed and sworn to before me this _________ day of ________________________, 20___, in the city of _____________________________________________________________ Notary Public __________________________ My Commission Expires: _________________ *Certificate, if signed by attorney, need not be under oath. NOTICE TO DEFENDANT YOU ARE HEREBY NOTIFIED THAT IF YOU DO NOT FILE AN OPPOSITION TO THIS APPLICATION WITHIN THIRTEEN DAYS OF THE DATE SET FORTH IN THE ABOVE CERTIFICATE, THE CLERK MAY TERMINATE THE STAY OF EXECUTION ON THE JUDGMENT ENTERED AGAINST YOU AS SET FORTH IN THIS APPLICATION. IF YOU WISH TO OPPOSE THIS APPLICATION, YOU OR YOUR ATTORNEY MUST FILE, WITHIN SUCH THIRTEEN DAY PERIOD, AN AFFIDAVIT OR OTHER STATEMENT SHOWING THAT YOU HAVE ACTUALLY COMPLIED WITH THE REQUIREMENTS OF THE STAY. IF YOU FILE SUCH AFFIDAVIT OR OTHER STATEMENT SHOWING THAT YOU HAVE ACTUALLY COPLIED WITH THE REQUIREMENTS OF THE STAY, THE MATTER WILL BE HEARD BY THE COURT, AND YOU WILL BE GIVEN NOTICE OF THE TIME AND PLACE OF HEARING. IF YOU WISH TO TALK TO AN ATTORNEY AND FEEL THAT YOU CANNOT AFFORD TO PAY A FEE TO AN ATTORNEY, PROMPTLY CONTACT ONE OF THE OFFICES OF THE LEGAL AID SOCIETY (628-1161) OR THE NEIGHBORHOOD LEGAL SERVICES (682-2700) OR HELP OR COME TO SUITE 5000 AT 500 INDIANA AVENUE, N.W. FOR MORE INFORMATION CONCERNING PLACES WHERE YOU MAY ASK FOR HELP. Form CV(6)-603/Feb. 2011 American LegalNet, Inc. www.FormsWorkFlow.com