The Commonwealth of MassachusettsS U F F O L K , s s . T R I A L C O U R T O F T H E C O M M O N W E A L T HB O S T O N M U N I C I P A L C O U R T D E P A R T M E N TPlaintiff(s)C i v i l A c t i o n N o . Defendant(s)REQUEST FOR DEFAULT JUDGMENT(Rule 55(b)).I, , the undersigned, request thatdefault judgment be entered against the following defendant(s):A.Damages/Principal amount claimed in complaint $B.Interest claimed $ Note: Interest must be calculated from the entry date of complaint unless a date of demand is stated in said complaint. Please provide a Memo of Damages if any payments have been made by the defendant(s).C.I further make affidavit that:1.The total amount due the plaintiff(s), exclusive of costs to be computed by theClerk, in this claim (A+B) is $ 2.The defendant(s) is/are not an infant(s) or incompetent person(s).3.That the defendant(s) is/are not in the military service of the United States or its Allies,as defined in the Servicemembers Civil Relief Act of 2003, as set forth in 50 U.S.C. App. 247247501 et seq., evidenced by the following facts: S u b s c r i b e d t h i s d a y o f , 2 0 u n d e r t h e p e n a l t i e s o f p e r j u r y .Attorney222s fees waived. Execution requested. (Signature of plaintiff/plaintiff222s counsel)(Printed name of signatory)(Address) (Area Code & Telephone Number)(BBO Number) B M C - C V - 0 2 9 R E Q U E S T F O R D E F A U L T J U D G M E N T ( R e v . 03/08 s w f ) American LegalNet, Inc. www.FormsWorkFlow.com