Revised 1/2005 Suggested Form D103 UNITED STATES BANKRUPTCY COURT WESTERN DISTRICT OF NEW YORK In Re: APPLICATION FOR ORDER GRANTING JUDGMENT BY DEFAULT AND AFFIDAVIT OF AMOUNT DUE [Bankruptcy Rule 7055(b)] (Core Proceeding) Debtor(s). BK Case No.____________ Plaintiff(s), AP Case No.____________ vs. Defendant(s). The undersigned, being duly sworn, deposes and states that: 1. I am an attorney admitted to practice in this Court and am the attorney to Plaintiff in this Adversary Proceeding or Plaintiff pro se. Defendant, ______________________________________ ("Defendant"), has failed to answer or otherwise appear in this action. Defendant is not an infant or incompetent person, nor is Defendant in the military service of the United States. In addition, Defendant is not the Debtor.1 Pursuant to Federal Rules of Bankruptcy Procedure ("Bankruptcy Rule") 7055(a), the Clerk of Court entered and certified the Fact of Default of Defendant, on _________________, 2_____. 2. 3. If the Defendant is the Debtor, Judgment by Default must be sought by Notice of Motion and Motion, pursuant to Bankruptcy Rule 9014. See, In Re Emmerling, 223 B.R. 860 (B.A.P. 2d Cir. N.Y. 1997). 1 Page 1 American LegalNet, Inc. www.USCourtForms.com 4. Pursuant to Bankruptcy Rule 7055(b), Plaintiff hereby requests that the Court 2 enter Judgment by Default in favor of Plaintiff and against Defendant for the relief demanded in the Complaint, as follows: the principal sum of $__________, plus interest 3 in the amount of $__________, pursuant to 28 U.S.C. § 1961 (at the rate of _____% per-annum for the period from _________________ through _________________), together with costs in the sum of $__________, for a total amount due in the sum of $__________. ________________________________ Attorney for Plaintiff or Plaintiff pro se Dated: _________________ Sworn to before me this ______ day of _________________, 2_____. _______________________________________ Notary The authority of the Clerk of Court to enter Judgment by Default, pursuant to Bankruptcy Rule 7055(b)(1), is limited in this District to actions involving post-petition accounts receivable. In all other instances, Judgment by Default must be sought from and granted by the Court, pursuant to Bankruptcy Rule 7055(b)(2). 3 2 To be computed by Plaintiff. Page 2 American LegalNet, Inc. www.USCourtForms.com