UNITED STATES DISTRICT COURT EASTERN DISTRICT OF NEW YORK ------------------------------------------------------x NOTATION OF DEFAULT Plaintiff, -CV-against- ( ) SAMPLE Defendant(s). ------------------------------------------------------x I, Douglas C. Palmer, Clerk of Court of the United States District Court for the Eastern District of New York, do hereby certify that the defendant has not filed an answer or otherwise moved with respect to the complaint herein. The default of defendant, ________________ is hereby noted pursuant to Rule 55(a) of the Federal Rules of Civil Procedure. Dated: Brooklyn, New York ,2000 ROBERT C. HEINEMANN DOUGLAS C. PALMER Clerk of Court By: Deputy Clerk American LegalNet, Inc. www.FormsWorkFlow.com UNITED STATES DISTRICT COURT EASTERN DISTRICT OF NEW YORK ------------------------------------------------------x NOTATION OF DEFAULT -CV- Plaintiff, ( ) -against- Defendant(s). ------------------------------------------------------x I, Douglas C. Palmer, Clerk of Court of the United States District Court for the Eastern District of New York, do hereby certify that the defendant has not filed an answer or otherwise moved with respect to the complaint herein. The default of defendant, ___________________________ is hereby noted pursuant to Rule 55(a) of the Federal Rules of Civil Procedure. Dated: Brooklyn, New York , 20 ROBERT C. C. PALMER DOUGLAS HEINEMANN Clerk of Court By: Deputy Clerk American LegalNet, Inc. www.FormsWorkFlow.com