STATE OF INDIANA COUNTY OF HAMILTON ) ) SS: ) HAMILTON SUPERIOR COURT NO. 4 CAUSE NO. 29D04-________-SC-___________ ___________________________________, ___________________________________, vs. Plaintiff(s), ___________________________________, ___________________________________, Defendant(s). VERIFIED MOTION FOR DEFAULT JUDGMENT The Plaintiff requests the Court to enter a default judgment against the Defendant(s) as set forth below. The Plaintiff states that, to the best of his/her knowledge and belief: 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. I have no reason to believe that the Defendant(s) is/are either a minor or incompetent. For purposes of complying with the Soldiers and Sailors Civil Relief Act of 1940, 50 USC 520, I have no reason to believe that the Defendant(s) is/are in the active military service of the United States. Th Defendant(s) owe(s) the Plaintiff(s) the following amounts: a. b. c. d. Damages/Principal Prejudgment Interest (if claimed) Attorney Fees (if claimed) Other ______________________ Total (excluding filing fees) $______________ $______________ $______________ $______________ $______________ I affirm, under the penalties for perjury, that the foregoing representations are true. Dated:___________________, 200__. ____________________________________ Plaintiff or Plaintiff=s Attorney DEFAULT JUDGEMENT The Court, being duly advised, hereby: G denies the motion for default judgment because __________________________________________________. G finds that the Plaintiff appeared and that the Defendant(s) failed to appear for first trial setting and grants the motion for default judgment. The Court orders the Clerk enter judgment in favor of the Plaintiff(s) and against the following Defendant(s) __________________________________________________________________ in the sum of $________________, plus court costs of $________ (total $_________________). RECOMMENDED BY: Dated: ___________________, 200__. Distribution: ____ Plaintiff/Attorney ____ Defendant/Attorney sc4form.065 (revised May 24, 2006) American LegalNet, Inc. www.FormsWorkFlow.com APPROVED AND ORDERED: ______________________________ Judge, Hamilton Superior Court 4 __________________________ Commissioner