IN THE UNITED STATES BANKRUPTCY COURT FOR THE NORTHERN DISTRICT OF WEST VIRGINIA IN RE: , Debtor. ___________________________________ , Plaintiff, vs. , Defendant. ) ) ) ) ) ) ) ) ) ) ) ) ) ) ) ) ) ) Case No. Chapter Adv. Proc. No. REQUEST FOR CLERK'S ENTRY OF DEFAULT AND AFFIDAVIT ________ (the "Plaintiff"), pursuant to Fed. R. Bankr. P. 7055; Fed. R. Civ. P. 55, hereby requests that the Clerk enter default against ___________ (the "Defendant"). As the docket sheet in this adversary proceeding reflects, the Defendant has failed to timely plead or otherwise defend the Plaintiff's claims. In support of this request, the Plaintiff submits the following Affidavit: AFFIDAVIT The undersigned, being duly sworn, upon oath deposes and says: 1. I am the attorney of record for the Plaintiff, and have personal knowledge of the facts set forth in this affidavit. 2. 3. 4. The Plaintiff filed this adversary proceeding against the Defendant on:_____ The Clerk issues a summons for service on the Defendant on:________ The Plaintiff's counsel timely served the summons and complaint on the Defendant on ______, which date is within 14 days from when the Clerk issued the summons. If not previously filed with the Clerk, attached to this Request for Entry of Default and Affidavit is the Certificate of 1 American LegalNet, Inc. www.FormsWorkFlow.com Service evidencing timely service of the Plaintiff's Complaint and Summons upon the Defendant. 5. The time for filing an answer (as set forth in Fed. R. Bankr. P. 7012) to the Plaintiff's Adversary Complaint has passed, with no answer being filed by the Defendant, and with no extension of time to file an answer being filed with the Court under Fed. R. Bankr. P. 9006(b)(1). 6. 7. To my knowledge, the Defendant has failed to otherwise defend the Plaintiff's claims. Less than 120 days have elapsed since service of the summons and complaint upon the Defendant. 8. I have investigated the Defendant's military status. I sought certificates from the Adjunct General of the Army, the Chief of Naval Personnel, and from the Major General Commandant of the United States Marine Corps as authorized by 50 U.S.C. § 582(a), (b). These certificates, attached as Exhibits ___ through ____ to this Affidavit, indicate that the Defendant [was never in the military service or did serve in the military, but was discharged on _______ (date)]. The Defendant is not now, nor at the time of the filing of this adversary complaint in the military service of the United States as defined by the Servicemembers and Civil Relief Act, 50 U.S.C. § 501 et seq. /s/________________________________ Name: Bar No.: Address: Tele. No.: SWORN and SUBSCRIBED before me on this ___ day of __________, 201__ ______________________ Notary Public 2 American LegalNet, Inc. www.FormsWorkFlow.com