COURT COUNTY OF ...................................................... : Index No. COURT .COUNTY.OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . :. . . . . . . . . . . ........ .. : -againstPlaintiff(s) : : Plaintiff(s) : Index No. AFFIDAVIT OF FACTS : CONSENT TO UPON APPLICATION FOR CHANGE ATTORNEY DEFAULT JUDGMENT : (Constituting Claim, Default and Amount Due) : -against- : : : : Defendant(s) : ...................................................... : Defendant(s) ....................................................... STATE OF NEW YORK ) ss.: ) IT IS HEREBY CONSENTED that (insert name of incoming attorney(s)) COUNTY OF ) with an office be substituted as attorney(s) of located at being duly sworn, deposes and says: record for the undersigned party(ies) in the above captioned action in place of the undersigned attorney(s) as of the 1. date of this the plaintiff in the above captioned action, and I submit this affidavit in support of the instant application I am Consent. for judgment by default pursuant to CPLR § 3215. Dated: This is an action for 2. * 3. (Party(ies) - sign above and commenced on or about (Outgoingby attorney - sign above and type name and office address This action was type name(s) below) below) service of a summons and upon the defendant(s) herein. 4. 5. 6. The time for the defendant(s) to answer or move with respect to the defendant(s) has/have not answered or moved with respect to the has expired, and the The defendant(s) time to plead has not been extended, and the defendant(s) is/are now in default in pleading. Pursuant to CPLR § 3215(f)(3), additional notice of the default was duly given by * at least 20 days before the entry of such judgment, by mailing a copy of the summons by first-class mail to the defendant at the defendant's place of residence in an envelope bearing the legend ''personal and confidential'' and not indicating on the outside of the envelope that the communication was from an attorney or concerns an alleged debt. ** (Acknowledgment by a person in New York State - Use Acknowledgment on following page if acknowledgment by a person outside New York State) State of New York *** Proof of service of the said additional notice is annexed hereto. ss.: County of WHEREFORE, deponent demands judgment against the defendant(s) in the sum of $ with interest from On togetherbefore me, the and disbursements of this action. with the costs undersigned, personally appeared Dated: personally known to me or proved to me on the basis of satisfactory evidence to be the individual(s) whose name(s) is/are subscribed to the within instrument and acknowledged to me that he/she/they executed the same in (Plaintiff must sign above and type name below) his/her/their Sworn to before me on capacity(ies), and that by his/her/their signature(s) on the instrument, the individual(s), or the person upon behalf of which the individual(s) acted, executed the instrument. 7. * Notary Public *Party(ies) must have signature(s) acknowledged. Insert ''me'' or ''my attorney(s)'', as the case may be. acknowledgement) (Signature and office of individual taking Insert any other information concerning circumstances of mailing - See CPLR § 3215(f)(3)(i) Pursuant to CPLR § 3215(f)(3)(ii), the affidavit of mailing of additional notice must be executed by person mailing the notice and filed with the judgment. 2003 © American LegalNet, Inc. www.USCourtForms.com www.USCourtForms.com ** *** COURT COUNTY OF ...................................................... (Acknowledgment by a subscribing witness outside New York State) : Index No. State of County of : : ss.: AFFIDAVIT OF FACTS On before me, Plaintiff(s) the undersigned, UPON APPLICATION FOR : -againstpersonally appeared DEFAULT JUDGMENT personally known to me or proved to me on the basis of satisfactory evidence to be Default and Amount Due) : (Constituting Claim, the individual(s) whose name(s) is/are subscribed to the within instrument and acknowledged to me that he/she/they executed the same in his/her/their capacity(ies), and that by his/her/their signature(s) on the instrument, the individual(s), or the person : upon behalf of which the individual(s) acted, executed the instrument, and that such individual made such appearance before the undersigned in (insert the city or other political subdivision and the state or county or other : place the acknowledgement was taken) Defendant(s) : ...................................................... STATE OF NEW YORK COUNTY OF ) ) ) ss.: (Signature and office of individual taking acknowledgement) being duly sworn, deposes and says: 1. 2. 3. 4. 5. 6. I am the plaintiff in the above captioned action, and I submit this affidavit in support of the instant application for judgment by default pursuant to CPLR § 3215. This is an action for This action was commenced on or about by service of a summons and upon the defendant(s) herein. The time for the defendant(s) to answer or move with respect to the defendant(s) has/have not answered or moved with respect to the has expired, and the The defendant(s) time to plead has not been extended, and the defendant(s) is/are now in default in pleading. Pursuant to CPLR § 3215(f)(3), additional notice of the default was duly given by * at least 20 days before the entry of such judgment, by mailing a copy of the summons by first-class mail to the defendant at the defendant's place of residence in an envelope bearing the legend ''personal and confidential'' and not indicating on the outside of the envelope that the communication was from an attorney or concerns an alleged debt. ** *** Proof of service of the said additional notice is annexed hereto. 7. WHEREFORE, deponent demands judgment against the defendant(s) in the sum of $ with interest from together with the costs and disbursements of this action. Dated: Sworn to before me on (Plaintiff must sign above and type name below) * Notary Public ** *** Insert ''me'' or ''my attorney(s)'', as the case may be. Insert any other information concerning circumstances of mailing - See CPLR § 3215(f)(3)(i) Pursuant to CPLR § 3215(f)(3)(ii), the affidavit of mailing of additional notice must be executed by person mailing the notice and filed with the judgment. 2003 © American LegalNet, Inc. American LegalNet, Inc. www.USCourtForms.com www.USCourtForms.com