UNITED STATES BANKRUPTCY COURT FOR THE DISTRICT OF RHODE ISLAND - - - - - - - - - - - - - - - -* In re: : : BK No. Chapter Debtor(s) : : Plaintiff(s) : vs. : AP No. Defendant(s) : - - - - - - - - - - - - - - - -* AFFIDAVIT IN SUPPORT OF APPLICATION FOR ENTRY OF DEFAULT I, , do hereby depose and say under oath that: 1. I am counsel for the plaintiff(s) in the above captioned matter and have personal knowledge of the facts set forth in this Affidavit; 2. day of The plaintiff(s) herein on the , filed in this action a Complaint against the defendant(s) herein, and was issued a Summons in connection therewith on 3. ; An examination of the Court files and records in this action shows that the defendant(s) was [were] duly served with a copy of the Summons, together with a copy of the plaintiff’s , by Complaint, on [indicate manner of service]; 4. Proof of such service was filed with the Court on ; 5. More than thirty (30) days [thirty five (35) days if service was on the United States or an officer or agency thereof] American LegalNet, Inc. www.USCourtForms.com have elapsed since service of the Summons and Complaint, and no Answer or Motion have been received within the time limit fixed by the Court or by Rule 7012(a); 6. To the best of affiant’s knowledge, information and belief, the defendant(s) is [are] not in the military service, as required by 50 U.S.C. app. §520, nor is [are] the defendant(s) herein infants or incompetent; and 7. This affidavit is executed by affiant in accordance with Rule 55(a) of the Federal Rules of Civil Procedure, for the purpose of enabling the plaintiff(s) herein to obtain an entry of default against defendant(s) for failure to plead or otherwise defend as to plaintiff’s Complaint. Signature of Attorney for Plaintiff Firm Name Attorney Name R.I. Bar ID # Business Address Tel # Fax # STATE OF RHODE ISLAND COUNTY OF PROVIDENCE Subscribed and sworn to at PROVIDENCE this , before me. day of NOTARY PUBLIC My commission expires: American LegalNet, Inc. www.USCourtForms.com