Attorney or Party Name, Address, Telephone & FAX Numbers, and California State Bar Number FOR COURT USE ONLY Attorney for UNITED STATES BANKRUPTCY COURT CENTRAL DISTRICT OF CALIFORNIA In re: Debtor. CHAPTER _________ Plaintiff(s), CASE NUMBER ADVERSARY NUMBER vs. DATE: TIME: Defendant(s). COURTROOM: DEFAULT JUDGMENT (WITHOUT PRIOR JUDGMENT) 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): 2. a. Plaintiff is awarded damages in the following amount: $ Plaintiff is awarded costs in the following amount: $ Plaintiff is awarded attorney fees in the following amount: $ d. G G G G e. G Plaintiff is granted the following relief (specify): G This Judgment or claim is determined to be non-dischargeable under: b. c. 3. 4. G Plaintiff is awarded interest at the rate of ________% per year from the following date to the date of entry of this Judgment (Specify date from which interest shall begin to run): The Court further adjudges as follows: Dated: ________________________________ G See Attached Page G G Bankruptcy Code § 523(a) _________ G See Attached Page Other (specify): ________________________________________________ JUDGE OF THE UNITED STATES BANKRUPTCY COURT CENTRAL DISTRICT OF CALIFORNIA This form is optional. It has been approved for use by the United States Bankruptcy Court for the Central District of California. January 2009 F 9021-1.4 Default Judgment (Based on Prior Judgment) - Page 2 In re F 9021-1.4 CHAPTER: Debtor. CASE NO.: NOTE: When using this form to indicate service of a proposed order, DO NOT list any person or entity in Category I. Proposed orders do not generate an NEF because only orders that have been entered are placed on a CM/ECF docket. PROOF OF SERVICE OF DOCUMENT I am over the age of 18 and not a party to this bankruptcy case or adversary proceeding. My business address is: A true and correct copy of the foregoing document described as will be served or was served (a) on the judge in chambers in the form and manner required by LBR 5005-2(d), and (b) in the manner indicated below: I. TO BE SERVED BY THE COURT VIA NOTICE OF ELECTRONIC FILING (“NEF”) - Pursuant to controlling General Order(s) and Local Bankruptcy Rule(s) (“LBR”), the foregoing document will be served by the court via NEF and hyperlink to the document. On ________________________ I checked the CM/ECF docket for this bankruptcy case or adversary proceeding and determined that the following person(s) are on the Electronic Mail Notice List to receive NEF transmission at the email addressed indicated below: G Service information continued on attached page II. SERVED BY U.S. MAIL OR OVERNIGHT MAIL (indicate method for each person or entity served): On _________________________ I served the following person(s) and/or entity(ies) at the last known address(es) in this bankruptcy case or adversary proceeding by placing a true and correct copy thereof in a sealed envelope in the United States Mail, first class, postage prepaid, and/or with an overnight mail service addressed as follow. Listing the judge here constitutes a declaration that mailing to the judge will be completed no later than 24 hours after the document is filed. G Service information continued on attached page III. SERVED BY PERSONAL DELIVERY, FACSIMILE TRANSMISSION OR EMAIL (indicate method for each person or entity served): Pursuant to F.R.Civ.P. 5 and/or controlling LBR, on _______________________ I served the following person(s) and/or entity(ies) by personal delivery, or (for those who consented in writing to such service method) by facsimile transmission and/or email as follows. Listing the judge here constitutes a declaration that mailing to the judge will be completed no later than 24 hours after the document is filed. G Service information continued on attached page I declare under penalty of perjury under the laws of the United States of America that the foregoing is true and correct. _________________________________________________________ Date Type Name _____________________________________ Signature This form is optional. It has been approved for use by the United States Bankruptcy Court for the Central District of California. January 2009 F 9021-1.4 Default Judgment (Based on Prior Judgment) - Page 3 In re F 9021-1.4 CHAPTER: Debtor. CASE NO.: ADDITIONAL SERVICE INFORMATION (if needed): This form is optional. It has been approved for use by the United States Bankruptcy Court for the Central District of California. January 2009 F 9021-1.4 Default Judgment (Based on Prior Judgment) - Page 4 In re F 9021-1.4 CHAPTER: Debtor. CASE NO.: NOTE TO USERS OF THIS FORM: 1) Attach this form to the last page of a proposed Order or Judgment. Do not file as a separate document. 2) The title of the judgment or order and all service information must be filled in by the party lodging the order. 3) Category I. below: The United States trustee and case trustee (if any) will always be in this category. 4) Category II. below: List ONLY addresses for debtor (and attorney), movant (or attorney) and person/entity (or attorney) who filed an opposition to the requested relief. DO NOT list an address if person/entity is listed in category I. NOTICE OF ENTERED ORDER AND SERVICE LIST Notice is given by the court that a judgment or order entitled (specify) was entered on the date indicated as ”Entered” on the first page of this judgment or order and will be served in the manner indicated below: I. SERVED BY THE COURT VIA NOTICE OF ELECTRONIC FILING (“NEF”) - Pursuant to controlling General Order(s) and Local Bankruptcy Rule(s), the foregoing document was served on the following person(s) by the court via NEF and hyperlink , the following person(s) are currently on the Electronic Mail to the judgment or order. As of Notice List for this bankruptcy case or adversary proceeding to receive NEF transmission at the email address(es) indicated below. 9 Service information continued on attached page II. SERVED BY THE COURT VIA U.S. MAIL: A copy of this notice and a true copy of this judgment or order was sent by United States Mail, first class, postage prepaid, to the following person(s) and/or entity(ies) at the address(es) indicated below: 9 Service information continued on attached page III. TO BE SERVED BY THE LODGING PARTY: Within 72 hours after receipt of a copy of this judgment or order which bears an “Entered” stamp, the party lodging the judgment or order will serve a complete copy bearing an “Entered” stamp by U.S. Mail, overnight mail, facsimile transmission or email and file a proof of service of the entered order on the following person(s) and/or entity(ies) at the address(es), facsimile transmission number(s), and/or email address(es) indicated below: 9 Service information continued on attached page This form is optional. It has been approved for use by the United States Bankruptcy Court for the Central District of California. January 2009 F 9021-1.4 Default Judgment (Based on Prior Judgment) - Page 5 In re F 9021-1.4 CHAPTER: Debtor. CASE NO.: ADDITIONAL SERVICE INFORMATION (if needed): This form is optional. It has been approved for use by the United States Bankruptcy Court for the Central District of California. January 2009 F 9021-1.4