IN THE COUNTY COURT, CIVIL DIVISION In and for Volusia County, Florida Case Number: Division: _____________________________ _____________________________ Plaintiff(s) -vs- AFFIDAVIT OF DEFAULT IN STIPULATION Defendant(s) State of Florida County of Volusia Before me this day personally appeared _____________________________________, Plaintiff in the abovestyled case, who duly sworn, deposes and says: that ________________________________________, Defendant in the above styled case, has not made the payments according to the Stipulation entered into on _______________________ and that the balance now due and owing is $________________ principal, $____________ interest, $____________ attorney fee and $__________ costs; that Plaintiff is now entitled to a Judgment against Defendant for the total amount of $___________________; that Plaintiff has delivered a copy of this Affidavit to the Defendant by hand or mail this ______ day of __________________________, 20 _____. Subscribed and sworn to (or affirmed) before me on __________________________________ by _____________________________ Signature Laura E. Roth Clerk of the Court ________________________________ (Name of affiant, deponent or other signer) He/She is personally known to me or has presented __________________________________ (type of identification) as identification By: ______________________________ (Seal) Deputy Clerk __________________________________ (Notary's signature and seal) CL-0292-0510 American LegalNet, Inc. www.FormsWorkFlow.com