Small Claims Form 3. 1 6 : Affidavit of Default In the Iowa District Court f or County Plaintiff(s) (Name) (Address) (Name) (Address) vs. Defendant(s) (Name) (Address) (Name) (Address) Affidavit of Default (Failure to Comply with Payment Plan) Small Claim No. 1 . The court entered judgment on the day of , 20 , in the amount of $ plus court costs in the amount of $ . 2 . The court further ordered that the judgment debtor(s) could satisf y the judgment by an installment payment plan of $ per beginning on the day of , 20 . 3 . The judgment debtor (s) has (have) failed to make installment payments as ordered. I certify under penalty of perjury and pursuant to the laws of the State of Iowa that the preceding is true and correct. Date: Signature of Affiant /s/ Filing Judgment Creditor or Attorney Law firm, for which filing is made, if applicable Mailing address P hone number Email address Additional Email address , if applicable American LegalNet, Inc. www.FormsWorkFlow.com