Superior Court of the District of Columbia CIVIL DIVISION CA Form 110-A Plaintiff vs. 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 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 I For these reasons, the Clerk should enter judgment in the amount of plus interest and cost and/or require the following: (Signature) (Address) Telephone: Form 90 O-1959-1 w-314 2001 © American LegalNet, Inc. 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 Address: Plaintiff or attorney for plaintiff Subscribed and sworn to before me this day 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 ENTER JUDGMENT 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 COMPLIED 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) FOR HELP OR COME TO ROOM JM 170 AT 500 INDIANA AVENUE, N. W. FOR MORE INFORMATION CONCERNING PLACES WHERE YOU MAY ASK FOR HELP. 2001 © American LegalNet, Inc.