N ebraska State Court Form MOTION AND AFFIDAVIT FOR DEFAULT JUDGMENTCC 3:19 New 05/15 Neb. Rev. Stat. 247 25. Page 1 of 1 IN THE COUNTY COURT OF COUNTY, NEBRASKA Plaintiff vs. Defendant Case MOTION AND AFFIDAVIT FOR DEFAULT JUDGMENT The plaintiff moves the ourt for an Order granting a default judgment against the defendant(s), , for the reason that the defendant(s) failed to appear or answer to the Complaint and proper service was had upon the defendant(s). The plaintiff swears that the defendant(s) is/are not now in the U.S. Military Service. If this suit is for services, the plaintiff will be entitled s fees per Neb. Rev. Stat. 247 25.1801, unless the judgment amount exceeds $4,000.00. Judgment Amount:$ Pre-Judgment Interest:$ Costs:$ Interest Rate Default Other: Date Signature (do not sign until a notary is present) Name (Plaintiff) Street Address/P.O. Box City/State/ZIP Code Phone E-mail Address Subscribed and sworn before me this day of , 20. Notary Public American LegalNet, Inc. www.FormsWorkFlow.com