STATE OF SOUTH DAKOTA :SS COUNTY OF MINNEHAHA ) )IN CIRCUIT COURT SECOND JUDICIAL CIRCUIT CIV. Plaintiff, vs. AFFIDAVIT FOR ATTORNEY’S FEES, STATEMENT OF ATTORNEYS FEES AND APPROVAL Defendant. STATE OF SOUTH DAKOTA :SS COUNTY OF MINNEHAHA ) ) __________, being first duly sworn, upon (his or her) oath deposes and says that (he or she) is the attorney for ________________, the Plaintiff in the above-entitled matter. Defendant’s indebtedness, that is the basis of this action, was to a “regulated lender” as defined by SDCL 54-3-14, and Plaintiff is, therefore, entitled to recover its attorney’s fees. The Defendant executed a contract, a copy of which is attached hereto as Exhibit A, in which the Defendant agreed upon default to pay all attorney’s fees incurred in the collection of Defendant’s indebtedness; therefore, the Plaintiff should be awarded its attorney’s fees in accordance with SDCL 54-3-13. Attached hereto is a statement of attorney’s fees and expenses that have been incurred or shall necessarily be incurred by Plaintiff in the above-entitled action. The amounts charged are fair and reasonable and total the sum of $_______________. Dated this _____ day of _____________, 20__. Subscribed and sworn to before me this _______ day of ______________, 20__. Notary Public, South Dakota My commission expires: ****************************************************************** STATEMENT OF ATTORNEYS FEES (here state and list fees and verify) ****************************************************************** APPROVAL OF ATTORNEY’S FEES Based upon the above Affidavit, attorney’s fees in the sum of $___________ are hereby approved. Dated this _____ day of _________, 20__. BY THE COURT: ____________________________ __ Circuit Court Judge ATTEST: Charles M. Fechner, Clerk of Courts By___________________________ Deputy (2nd Circuit Default Judgment form #4, August, 2004)