Fill and Sign the New York Application for Default Judgment in the State of New York Civil Case Form

Civil Court of the City of New York County of ______________________ Index Number _________________ ____________________________________ APPLICATION FOR JUDGMENT Claimant(s)/Plaintiff(s) , Am ount C laimed , less an y credits ________ -aga inst- Interest @____% from___/___/___ ________ Attorney Fees (if applicable) __________ SUBTOT AL __________ Defendant(s), Cos ts, by Statu te __________ ____________________________________________ D isbu rsem en ts State of New Yo rk, C ounty of___ __ __ __ __ __ __ __ __ _:ss . Service of Summons & Comp laint__________ Filing of Summons & C omplaint __________ Prospective Marshal’s Fee __________ Other (Indicate)______________ __________ Other (Indicate)______________ __________ Att orney Affirmat ion GRAND TO TAL__________ The undersigned, an Attorney at Law of the State of New York and (one of) the attorney(s) of record for___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ __ _ ___ ___ __(one of) the ____ ___ ___ ___ ___ ___ (s) in the above entitled action, affirms that the disbursements specified have been or will be made or incurred. My client is e ntitled to a J udgm ent: Q on Default, due to the fact that the Defendant(s) did not file an answer within the time permitted by law. Q based up on: Q Inquest Court Q Inquest Clerk Q Judge’s Order Q Arbitration Q Trial Q Failure to Comply with Stipulation Q Other (specify)____________________ I affirm that I have complied with the provisions of CPLR § 321 5(g) Q as per annexed A ffidavit or Affirmation Q by personally enclosing a copy of the Summons and Complaint in a First Class mail post-paid sealed envelope properly addressed to the Defendant’s Q plac e of reside nce:* Q place of employment;* Q last known resid ence :* Q by per sona lly enclosing a c opy of the Su mm ons a nd C omp laint, acc omp anied b y a notice to the c orp oration that service has been made pursuant to BCL § 306 , in a First Class mail post-paid envelope properly addressed to the defendant c orp oration at its last kn own corp orate addr ess:* *(Insert address here) at ___________________________________________ on _________________________, and depositing the envelope in an official depository under the exclusive care and custody of the United States Postal Service. The envelope bore the legend “Personal and Confidential” and there was no indication on the outside o f the envelop e that the c omm unicatio n wa s from a n attorn ey or that it conc erne d an alle ged de bt, an d it has not been returned by the Postal Service. I further affirm, under the penalties of perjury, that the above statements herein are true. Dated: Affirmed: JUDGMENT N ow, on Mo tion of __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ _, the attorney for ____ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ _,it its adjudged that the following Judgment Creditor(s), residing at the address(es) indicated below, recover of the following Judgment Debtor(s) at the address(es) indicated: Judgm ent Creditor Ju dgm ent C redit or’s A ddr ess Judgm ent Debtor Ju dgm ent D ebtor ’s Ad dress 1._______________________ ___________________1.____________________ _____________________ 2._______________________ ___________________2.____________________ _____________________ 3._______________________ ___________________3.____________________ _____________________ the sum of ____ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ _ as calculated above, and that the Judgment Creditor(s) have execution therefor. ENTRY OF JUDGMENT In accordance with CPLR § 3215 (a), if this Judgment is entered against less than all Defendants, this action is ordered severed as to any remaining Defendant(s). Date:____________________________________ Chief Clerk:________________________ By:___________. CIV-GP-55(Revised 11/03)- i