Approved, SCAO Original - Court 1st copy - Applicant Copies - All other parties STATE OF MICHIGAN JUDICIAL DISTRICT JUDICIAL CIRCUIT Court address CASE NO. DEFAULT REQUEST, AFFIDAVIT, AND ENTRY Court telephone no. Plaintiff name(s), address(es), and telephone no(s). Defendant name(s), address(es), and telephone no(s). v Plaintiff's attorney, bar no., address, and telephone no. Defendant's attorney, bar no., address, and telephone no. Party in default: REQUEST AND AFFIDAVIT 1. I request the clerk to enter the default of the party named above for failure to plead or otherwise defend as provided by law. 2. The defaulted party is not an infant or incompetent person. 3. It is unknown whether the defaulted party is in the military service. The defaulted party is not in the military service. The defaulted party is in the military but there has been notice of pendency of the action and adequate time and opportunity to appear and defend has been provided. Attached, as appropriate, is a waiver of rights and protections provided under the Servicemembers Civil Relief Act. Facts upon which this conclusion is based are: (specify) 4. This affidavit is made on my personal knowledge and, if sworn as a witness, I can testify competently to the facts in this affidavit. Applicant/Attorney signature Bar no. Subscribed and sworn to before me on My commission expires: Date Date , Signature: Deputy court clerk/Notary public County, Michigan. Notary public, State of Michigan, County of NOTE: Default can be entered by a district court clerk without the request of a party. DEFAULT ENTRY The default of the party named above for failure to plead or otherwise defend is entered. Date Court clerk CERTIFICATE OF MAILING I certify that on this date I served copies of this default on the appropriate parties or their attorneys by first-class mail addressed to their last-known addresses as defined by MCR 2.107(C)(3). Date MC 07 (3/10) Signature DEFAULT REQUEST, AFFIDAVIT, AND ENTRY MCL 32.517, MCL 600.2441, MCL 600.5759, MCR 2.603, 50 USC 521 American LegalNet, Inc. www.FormsWorkFlow.com