Attorney or Party Name, Address, Telephone & FAX Nos., State Bar No. & Email Address FOR COURT USE ONLY Debtor(s) appearing without attorney Attorney for: UNITED STATES BANKRUPTCY COURT CENTRAL DISTRICT OF CALIFORNIA In re: CASE NO.: CHAPTER: ADVERSARY NO.: Debtor(s) DEFAULT JUDGMENT (BASED ON PRIOR JUDGMENT) DATE: TIME: COURTROOM: PLACE: Plaintiff(s) vs. Defendant(s) Based on the Defendant's failure to respond to the complaint, the court renders its judgment as follows: 1. Judgment shall be entered in favor of Plaintiff (specify name): and against Defendant (specify name): The liability resulting from the judgment previously entered in favor of the Plaintiff as described below is Bankruptcy Code § 523(a) determined to be non-dischargeable under: Other (specify): 2. Case: Court: A copy of the underlying judgment is attached. This form is optional. It has been approved for use by the United States Bankruptcy Court for the Central District of California. December 2013 Page 1 F 7055-1.2.DEFAULT.JMT.PRIOR 3. a. b. c. Plaintiff is awarded costs in the following amount: $ Plaintiff is awarded attorney fees in the following amount: $ Plaintiff is granted the following relief (specify): See attached page 4. The court further orders (specify): See attached page Date: _____________________ United States Bankruptcy Judge This form is optional. It has been approved for use by the United States Bankruptcy Court for the Central District of California. December 2013 Page 2 F 7055-1.2.DEFAULT.JMT.PRIOR