STATE OF INDIANA ) ) SS: COUNTY OF HAMILTON ) ________________________________ Plaintiff(s) vs. IN THE SUPERIOR COURT NO. 6 OF HAMILTON COUNTY CAUSE NO. 29D06-___________________________ ______________________________________ Defendant(s) AFFIDAVIT FOR DEFAULT The plaintiff in this case states that, to the best of his/her knowledge and belief: 1. The defendant(s) in this case, _________________________________________, was/were served with a copy of the Notice of Claim in this case and has/have failed to appear for trial or plead after receiving proper notice. 2. The defendant(s), __________________________________________________, is/are not a minor nor incompetent and the basis of my knowledge of this is as follows: (Check one) ____ (a) I know the defendant(s) ____________________________________, and of my own personal knowledge, I am aware of these facts. ____ (b) I have carefully investigated whether the defendant(s) is/are a minor and received information from ______________________________________ who personally knows the defendant(s) and knows that the defendant(s) is/are not a minor or incompetent. 3. For purposes of complying with the Servicemembers Civil Relief Act of 2003, 50 U.S.C. App.Sec. 501, et seq, I state that: (Check one) American LegalNet, Inc. www.FormsWorkFlow.com ____ (a) Defendant(s) is/are not in the active military service of the United States and the source of my knowledge is: (Give facts known to you such as where the defendant(s) live(s), age of defendant(s) if beyond military age, defendant(s)'s employment, etc.) ___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ ____ (b) I am unable to ascertain whether or not the defendant(s) is/are in the active military service of the United States. 4. There are no set-offs or counterclaims in favor of the defendant(s0 against the plaintiff(s). 5. There is due and owing by the defendant(s) to the plaintiff(s) the following: a) Damages b) Interest c) Attorney fees d) Other _________________ TOTAL Court costs $__________________ $__________________ $__________________ $__________________ $__________________ $__________________ I affirm, under the penalties for perjury, that the foregoing representations are true. ____________________________ Date Rev. 1/07 Affidavit for Default _________________________________ Plaintiff American LegalNet, Inc. www.FormsWorkFlow.com