Small Claims 226 Motion for Default Judgment & Defendant Status Declaration Page 1 of 1 (Aug 2019) IN THE CIRCUIT COURT OF THE STATE OF OREGON FOR THE COUNTY OF Small Claims Department Case No. Plaintiff v . MOTION FOR DEFAULT JUDGMENT & DEFENDANT STATUS DECLARATION Defendant Attach Completed Small Claim General Judgment Form I, (name) , request a default judgment against (name) for: 1. A money award $ 2. Prejudgment interest $ 3. Costs and service expenses $ 4. P revailing party fee (ORS 20.190) $ I request the following terms in addition to or instead of a money award: post-judgment interest at the statutory rate (or % per year by agreement of the parties (attach copy of agreement)) other (describe property requested): I certify that: 1. The above-named defendant was properly served with a copy of the claim and failed to pay or deny the claim within 14 days; and 2. The person I request judgment against is not a minor, a protected person, a respondent, or incapacitated, as these terms are defined in ORS 125.005; and is in active military service. A signed waiver is attached (attach signed SCRA waiver) (or) is not in active military service* Certificate of Service or printout from Dept. of Defense website attached (or) describe facts that support this statement I am unable to determine whether this person is in military service. Describe reason Plaintiff is a debt buyer or debt collector acting on behalf of a debt buyer The initial pleading in this case did or did not comply with ORS 646A.670(1) and UTCR 5.180 I hereby declare that the above statements are true to the best of my knowledge and belief, and that I understand they are made for use as evidence in court and I am subject to penalty for perjury. Date Signature Name (print) *Certain members of the military may be protected by the Servicemembers Civil Relief Act (SCRA) (50 U.S.C. App. 501 to 596). You cannot get a default judgment against a member of the military who is protected by this law unless other legal steps are followed or the defendant signs a waiver. Talk to a lawyer if you have concerns. Total judgment award: $ American LegalNet, Inc. www.FormsWorkFlow.com