Fill and Sign the I Am a Member of the Bar of This Court and Am Associated with the Firm of Form

SDNY Web 5/99 UNITED STATES DISTRICT COURT SOUTHERN DISTRICT OF NEW YORK- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -x Plaintiff,____ Civ. _______ ( ) - against - AFFIDAVIT FOR JUDGMENT BY DEFAULT Defendant. - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -x STATE OF NEW YORK ) )ss.: COUNTY OF NEW YORK ) ___________________________________, being duly sworn, deposes and says: 1. I am a member of the Bar of this Court and am associated with the firm of _________________________________, attorneys for plaintiff in the above-entitled action and Iam familiar with all the facts and circumstances in this action. 2. I make this affidavit pursuant to Rule 55.1 and 55.2(a) of the Civil Rules for the Southern District of New York, in support of plaintiff's application for the entry of a defaultjudgment against defendant. 3. This is an action to recover ______________________ owed by defendant to plaintiff for __________________________________________________. 4. Jurisdiction of the subject matter of this action is based on jurisdiction. 5. This action was commenced on (date) by the filing of the summons and complaint. A copy of the summons and complaint was served on the defendant on -2- SDNY Web 5/99 (date) by personal service on (name) , (STATE SPECIFICALLY HOW SERVICE WAS MADE ON DEFENDANT) and proof of service by the Special Process Server was filed. The defendant has not answered the complaintand the time for the defendant to answer the complaint has expired. 6. This action seeks judgment for the liquidated amount of $___________, plus interest at ________% from (date) , for a total as of (date) of $___________, as shown by the annexed Statement, which is justly due and owing, and no part of which has been paid except as therein set forth. 7. The disbursements sought to be taxed have been made in this action or will necessarily be made herein. WHEREFORE, plaintiff requests the entry of Default and the entry of the annexed Judgment against defendant. Dated: New York, New York (date) ______________________________________ (Attorney's name) Sworn to before me this _____day of _____________, ________. _____________________________ Notary Public IF DEFENDANT IS AN INDIVIDUAL, ATTORNEY'S AFFIDAVIT MUST CONTAIN A STATEMENT THAT HE OR SHE IS NOT A MINOR, MENTALLY INCOMPETENT NOR IN THE MILITARY SERVICE OF THE UNITED STATES.