Fill and Sign the Affidavit for Default Eviction Indiana Form

IN THE SUPERIOR COURT NO. _______________ OF ____________________________ COUNTY STATE OF INDIANA ) ) SS: COUNTY OF ____________________________ ) ____________________________ Plaintiff(s) CAUSE NO. ____________________________ Vs. ____________________________ Defendant(s) AFFIDAVIT FOR DEFAULT (Eviction) The undersigned states that, to the best of his/her knowledge and belief: 1. The defendant(s), ____________________________ , was / were legally served with a copy of the Notice of Claim in this case and has / have failed to appear for trial or plead after receiving proper notice. 2. The defendant(s) is / are not under age 18 or otherwise legally incompetent. 3. For purposes of complying with the Servicemembers Civil Relief Act of 2003, 50 U.S.C. App.Sec. 501, I state that: (Check one) (a) Defendant(s) is / are not in the active military service of the United States. (b) I am unable to ascertain whether or not the defendant(s) is / are in the active military service of the United States. 4. The plaintiff(s) rented to the defendant(s) the property located at: ____________________________ at a rate of $ _________ per month payable in advance on the _________ day of each month. 5. The defendant(s) has / have violated the rental agreement with the plaintiff(s) by: (a) Failing to pay rent / late fees / utilities (circle those that apply) currently totaling $ _________ and / or (b) ____________________________ 6. The defendant(s); remain(s) in the property; has / have vacated the property The defendant(s) did did not leave property of value on the premises. 7. Plaintiff(s) hold a security deposit in the amount of $ _________ . The plaintiff(s) has have complied will comply with the Indiana Security Deposit Act. 8. There are no set-offs or counterclaims in favor of the defendant(s). 9. There is due and owing by the defendant(s) to the plaintiff(s) the following: 10. Plaintiff(s) request(s) eviction effective on ____________________________ . 11. Plaintiff(s) request(s) entry of a money judgment effective this date. OR 12. Plaintiff(s) request(s) that the Court set a damages hearing. I affirm, under the penalties for perjury, that the foregoing representations are true. $ ____________________ ___________________________________ Date Plaintiff / Plaintiff’s counsel Rev. 1/07 Affidavit for Default (Eviction) a) Rent $ ____________________ b) Damages $ ____________________ c) Utilities $ ____________________ d) Interest $ ____________________ e) Late fees $$ ____________________ f) Attorney fees $ ____________________ g) Other _______________ $ ____________________ TOTAL $ ____________________ Court Costs $ ____________________