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 (WITHOUT 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): a. b. c. d. 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: $ $ $ 2. 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): 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 e. Plaintiff is granted the following relief (specify): See attached page 3. This judgment or claim is determined to be non-dischargeable under: Other (specify): Bankruptcy Code §523(a) 4. The court further orders: 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