IN THE CIRCUIT COURT OF THE STATE OF OREGON FOR LINCOLN COUNTY Small Claims Department ) ) ) ) ) ) ) ) Case No. _________________________ MOTION FOR DEFAULT JUDGMENT AND DEFENDANT STATUS DECLARATION Plaintiff v. Defendant Attach Completed Small Claims General Judgment Form I, (name) 1. A money award 2. Prejudgment interest 3. Costs and service expenses , request a default judgment against (name) $ $ $ for: Total judgment award: $ 4. Prevailing party fee (ORS $ 20.190) I request the following terms in addition to or instead of a money award: postjudgment interest at the statutory rate (or _____% per year by agreement of the parties (attach copy of agreement)) other (describe property requested): I certify that: 1. The above-named defendant was properly served with a copy of the claim and failed to pay or deny the claim within 14 days; and 2. The person I request judgment against is not a minor, a protected person, a respondent, or incapacitated, as these terms are defined in ORS 125.005; and is in active military service. A signed waiver is attached (attach signed SCRA waiver) (or) is not in active military service* Certificate of Service or printout from Dept. of Defense website attached (or) describe facts that support this statement I am unable to determine whether this person is in military service. Describe reason I hereby declare that the above statements are true to the best of my knowledge and belief, and that I understand they are made for use as evidence in court and I am subject to penalty for perjury. Date Signature Name (print) *Certain members of the military may be protected by the Servicemembers Civil Relief Act (SCRA) (50 U.S.C. App. 501 to 596). You cannot get a default judgment against a member of the military who is protected by this law unless other legal steps are followed or the defendant signs a waiver. Talk to a lawyer if you have concerns. Form 15.010.1b ­ MOTION FOR DEFAULT JUDGMENT AND DEFENDANT STATUS DECLARATION ­ UTCR 15.010(1)(b) (Revised 8-1-12) Case No. American LegalNet, Inc. www.FormsWorkFlow.com