Original - Court
1st copy - Applicant
Copies - All other parties

Approved, SCAO

STATE OF MICHIGAN
JUDICIAL DISTRICT
JUDICIAL CIRCUIT

CASE NO.
DEFAULT
REQUEST, AFFIDAVIT, AND ENTRY

Court address

Court telephone no.

Plaintiff name(s), address(es), and telephone no(s).

Defendant name(s), address(es), and telephone no(s).

v

Defendant's attorney, bar no., address, and telephone no.

Plaintiff's attorney, bar no., address, and telephone no.

Party in default:
REQUEST AND AFFIDAVIT
1. I request the clerk to enter the default of the party named above for failure to plead or otherwise defend as provided by law.
2. The defaulted party is not an infant or incompetent person.
3.

It is unknown whether the defaulted party is in the military service.
The defaulted party is not in the military service.
The defaulted party is in the military but there has been notice of pendency of the action and adequate time and opportunity to appear and defend has been provided. Attached, as appropriate, is a waiver of rights and protections provided under the
Servicemembers Civil Relief Act. Facts upon which this conclusion is based are: (specify)

4. This affidavit is made on my personal knowledge and, if sworn as a witness, I can testify competently to the facts in this affidavit.
Applicant/Attorney signature

Subscribed and sworn to before me on
My commission expires:

,

Date

Date

Signature:

Bar no.

County, Michigan.
Deputy court clerk/Notary public

Notary public, State of Michigan,