DEFAULT ACTION COVER SHEET - A Anyone seeking a judgment on a collection must complete and sign this sheet. The sheet must accompany the pleading. 1. Is suit on file? _____ (must file) 2. Is affidavit of default prepared and filed? _____ (must prepare and file) 3. Was any partial payment made on the debt? _____ credited? _____ 4. Was collateral involved in the transaction? _____ 5. Please state the original value of collateral. __________ 6. Was the collateral repossessed? _____ 7. What proceeds resulted from the sale of the collateral? __________ 8. Have the proceeds been credited against the debt? _____ 9. Are you requesting pre-judgment interest? _____ Please state the amount and rate. Amount __________ rate _____ Please include Forms #1 and #5, or Form #9alt.(or their equivalents). 10. Is this an open account collection? _____ If yes, interest is limited to ten percent. (Category B, SDCL 54-3-16, as established by Scotland, etc. v. ABA, etc., 583 N.W.2d 834 (SD 1998)). 11. Are you requesting attorney fees? _____ If so, please state the amount __________. Was an attorney used in the prosecution of this claim? _____ Please include form #1 and #4 or their equivalents. ONLY REGULATED LENDERS AS DEFINED BY SDCL 54-3-14 MAY COLLECT ATTORNEYS FEES. (SEE SDCL 15-17-39 AND SDCL 54-3-13.) Are you a regulated lender? _____ Please state type of lender or assignment.______________________________________________________________ _______________________________________________________________________. 12. If using this cover sheet, procedure requires that disbursements, interest and attorney fees must be taxed separately and may not be included in the proposed judgment. Dated ________________________ Has the partial payment been Was the collateral sold? _____ Plaintiff or attorney ____________________________ (2nd Circuit Default Judgment form #6A, August, 2004)