COMMONWEALTH OF MASSACHUSETTS DISTRICT COURT DEPARTMENT DIVISION DOCKET NO. ________________________________________________________________ v. ________________________________________________________________ REQUEST FOR DEFAULT (Rule 55 (a)) I, __________________________________________________________ the undersigned, for the above-named plaintiff(s) ____________________________________________, state that the complaint in this action was filed on __________________, and the summons and a copy of the complaint were served on defendant(s) ______________________________________ on _______________________, as appears from the officer's return; and that the defendant(s) herein has (have) failed to serve a responsive pleading or to otherwise defend as provided by rule. Therefore, I request that default be entered against defendant(s) _______________________________________________ in this action. Signed under the penalties of perjury. Signature_____________________________________________ Name_________________________________________________ Address_______________________________________________ DATE ________________________ _____________________________________________________ Telephone _____________________________________________ American LegalNet, Inc. www.FormsWorkflow.com