COURT COUNTY OF ................................................................. : Index No. : : Plaintiff(s) -against- : : : : AFFIDAVIT OF CONFESSION OF JUDGMENT Defendant(s) : ................................................................. STATE OF NEW YORK, COUNTY OF the defendant herein. the of a corporation and possesses the authority to make this affidavit on behalf of the corporate defendant herein. The defendant hereby confesses judgment herein and authorizes its entry against defendant in the sum of dollars ($ The defendant resides at in the County of , State of . The defendant authorizes entry of judgment in ). ss.: being duly sworn, deposes and says that deponent is County, New York, if said residence address is not in New York State. This confession of judgment for a arises from the following facts: debt justly due to the plaintiff debt justly to become due to the plaintiff This affidavit if made in connection with an agreement for the purchase for $1,500.00 or less of any commodities for any other than a commercial use or business use upon any plan of deferred payments whereby the price or cost is payable in two or more installments, was executed subsequent to the time a default occurred in the payment of an installment thereunder. (sign name) (print name) Sworn to before me this day of , 20 . (sign name) (print name) American LegalNet, Inc. www.FormsWorkflow.com COURT . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . : : : COUNTY OF Index No. Address of Plaintiff: Plaintiff(s) -against- : : : : JUDGMENT BY CONFESSION Defendant(s) : ................................................................. Amount confessed .................................................................................................................... $ Interest Subtotal $ Cost by statute ........................................................................................................... $ Transcript ................................................................................................................... Fees on execution ...................................................................................................... Satisfaction ................................................................................................................ Filing fee .................................................................................................................... Subtotal (costs/disbursements) $ Total STATE OF NEW YORK, COUNTY OF $ ATTORNEY'S AFFIRMATION The undersigned, attorney at law of the State of New York, affirms that (s)he is attorney of record for the plaintiff(s) and states that the above disbursements are correct and true and have been or will necessarily be made and are reasonable in amount and affirms this statement to be true under the penalties of perjury. Dated: (sign name) (print name) Attorney for Plaintiff(s) / Address & Phone JUDGMENT entered the day of , 20 . On filing the affidavit of Confession of Judgment made by the defendant(s) herein, sworn to the , 20 NOW, ON MOTION OF attorney(s) for the plaintiff(s), it is ADJUDGED that day of , , plaintiff(s), residing at , do recover of , defendant(s), residing at , the sum of $ with interest of $ , making a total of $ , together with $ costs and disbursements, amounting in all to the sum of $ , and that the plaintiff(s) has (have) execution thereof. Clerk American LegalNet, Inc. www.FormsWorkflow.com