MIED (Rev. 5/05) Request for Clerk's Entry of Default UNITED STATES DISTRICT COURT EASTERN DISTRICT OF MICHIGAN Plaintiff(s), v. Case No. Judge Magistrate Judge Defendant(s). / REQUEST FOR CLERK'S ENTRY OF DEFAULT In accordance with Fed. R. Civ. P. 55(a), I request that a Clerk's Entry of Default be entered against for failure to plead or otherwise defend. AFFIDAVIT In support of my request for Clerk's Entry of Default, I state that: 1. The summons and complaint were served on at by . [certified mail, regular mail, personal service, waiver of service] 2. The defendant has failed to plead or otherwise defend in accordance with Fed. R. Civ. P. 12. 3. The defendant is not an infant, incompetent person or a member of the military service. 4. This statement is true and is signed under the penalty of perjury. Date: Signature Bar No. Street Address City, State, Zip Code Telephone Number Primary Email Address American LegalNet, Inc. www.FormsWorkFlow.com