Address City State Zip Code IN THE COUNTY COURT OF THE SEVENTH JUDICIAL CIRCUIT IN AND FOR ST. JOHNS COUNTY, FLORIDA CASE NO.: DIVISION: , Plaintiff (s) , vs. , Defendant ( s ) . AFFIDAVIT OF DEFAULT Before me, the undersigned authority, personally appeared , who being first duly sworn, deposes and says: The D efendant , has failed to comply with the Stipulation dated , 20 , in which said Defendant admitted a debt in the sum of $ and agreed to pay Plaintiff, the amount of $ monthly / weekly until paid in full. Defendant has defaul ted in payments as of , 2017 and owes Plaintiff $; and therefore, Plaintiff requests a Final Judgment be entered in the sums of $ together with costs in the amount of $. CERTIFICATE OF SERVICE I HEREBY CERTIFY that a true copy of the foregoing has been furnished by U.S. Mail/Email/hand delivery on this day of , 20 to Defendant at . Affiant, SWORN TO AND SUBSCRIBED BEFORE ME THIS day of , 20 . Deputy Clerk American LegalNet, Inc. www.FormsWorkFlow.com