Fill and Sign the Ex Parte Application for Earnings Assignment Form

Notice of Default by Assignee to Obligor __________________________________________ (Name of Obligor)______________________________________________________________ (Street Address or Post Office Box of Obligor)________________________________________________________________________ (City, State, Zip Code) Please take notice that you are in default in the amount of $________________ (dollar amount) , having failed to make the following payments of principal and interest due to me on the indebtedness of $____________________ (dollar amount), described in an assignment, dated ______________________________________ (date), made by _________________________________________________ (Name of Assignor) to me. Date Payment Due Amount Due ___________________ ______________________ ___________________ ______________________ ___________________ ______________________ Total Now Due $_____________________ A copy of this Assignment is attached to this Notice. The default has continued for more than _____days. Unless payment is made within _______ (number) days from the date of mailing of this notice, I will bring a collection action in the _______________ _________________________________________________________ (designate court). Witness my signature this ___________________________________ (date). ________________________________________________________________________ (Name and Signature of Assignee)