STATE OF RHODE ISLAND AND PROVIDENCE PLANTATIONS DISTRICT COURT ___________________________, S.C. _______________ Division _______________________________________ Plaintiff vs. _______________________________________ Defendant Civil Action No. ___________________ APPLICATION TO CLERK FOR ENTRY OF DEFAULT The Plaintiff in the above-entitled action pursuant to Rule 55(a) of the Rhode Island District Court Rules of Civil Procedure hereby makes application to the Clerk for Entry of Default for the Plaintiff against the Defendant for failure of said Defendant to plead or otherwise defend. Said failure of the Defendant to plead or otherwise defend is set forth in the affidavit immediately following this application. The Plaintiff By his/her/its Attorney _______________________________ AFFIDAVIT The undersigned, being duly sworn, upon oath deposes and says: 1. That he/she is the attorney of record for the Plaintiff and has personal knowledge of the facts set forth in this affidavit; 2. That the Plaintiff on the __________ day of ___________________, 20_____, filed in this action a Complaint against the Defendant; 3. That examination of the court’s records in this action shows that the Defendant was duly served with a copy of the Summons and a copy of the Plaintiff’s Complaint; 4. That more than _____ days have elapsed since service of the Summons and Complaint; 5. That the Defendant has failed to plead or otherwise defend as to the Plaintiff’s Complaint; and 6. That this affidavit is executed by affiant herein in accordance with Rule 55(a) of the Rhode Island District Court Rules of Civil Procedure for the purpose of enabling the Plaintiff to obtain an Entry of Default against the Defendant for failure to plead or otherwise defend as to the Plaintiff’s Complaint. ________________________________ AFFIANT DC-36 (revised November 2011) American LegalNet, Inc. www.FormsWorkFlow.com Subscribed and sworn to before me in __________________________________ in the County of _____________________________ in the State of ____________________________ this ______day of 20____. Notary Public: ____________________________________ My commission expires: ________________________ Notary identification number: _______________ AFFIDAVIT AS TO MILITARY SERVICE AND COMPETENCY The undersigned, being duly sworn, upon information and belief deposes and say: That the Defendant is not an infant or an incompetent, and presently resides at __________________________________________________ in ________________________, Rhode Island; and [PLEASE CHECK THE APPLICABLER BOX] □ That the Defendant was not at the commencement of the above-entitled action, nor is now, in the “Military Service” of the United States as defined in the Servicemember’s Civil Relief Act, 50 App. U.S.C. § 521, nor is the Defendant an American citizen serving with the forces of a United States ally or a reservist/draftee called to active duty; or □ That despite exercising due diligence, the Plaintiff lacks sufficient information and has been unable to determine whether the Defendant is in “Military Service.” ________________________________ AFFIANT Subscribed and sworn to before me in __________________________________ in the County of _____________________________ in the State of ____________________________ this ______day of 20____. Notary Public: ____________________________________ My commission expires: ________________________ Notary identification number: _______________ ENTRY OF DEFAULT It appearing that the Defendant in the above-entitled action has failed to plead or otherwise defend as provided by the Rhode Island District Court Rules of Civil Procedure, now therefore DEFAULT is hereby entered for the Plaintiff and against the said Defendant this __________ day of ____________________________, 20____. ________________________________ CLERK DC-36 (revised November 2011) American LegalNet, Inc. www.FormsWorkFlow.com