The Commonwealth of Massachusetts

T R I A L C O U R T O F T H E C O M M O N W E A L T H
B O S T O N M U N I C I P A L C O U R T D E P A R T M E N T

S U F F O L K , s s . 

P la in tiff(s )

D e fe n d a n t(s )

I, 

1.

2.

3.

C i v i l  A  c t i o n  N  o .   

R E Q U E S T  F O R  D E F A U L T  J U D G M E N T
(Rule 55(b)).

default judgment be entered against the following defendant(s):

,  the  undersigned,  request that

Damages/Principal amount claimed in complaint

A.

B.

Interest claimed

   $

   $ 

 Note: Interest must be calculated from the entry date of complaint unless a date of demand is stated in said complaint. 
Please provide a Memo of Damages if any payments have been made by the defendant(s).

C.

I further make affidavit that:

The total amount due the plaintiff(s), exclusive of costs to be computed by the
Clerk, in this claim (A+B) is

   $ 

The defendant(s) is/are not an infant(s) or incompetent person(s).

That the defendant(s) is/are not in the military service of the United States or its Allies,
as defined in the Servicemembers Civil Relief Act of 2003, as set forth in 50 U.S.C. App. §§
501 et seq., evidenced by the following facts: 

S u b s c r i b e d t h i s 

   d a y o f 

   , 2 0 

            u n d e r t h e p e n a l t i e s o f p e r j u r y .

Attorney’s fees waived.

(Printed name of signatory)

(Signature of plaintiff/plaintiff’s counsel)

Execution requested.

(Address)

 

(Area Code & Telephone Number)

(BBO Number)

B M C - C V - 0 2 9 

R E Q U E S T F O R D E F A U L T J U D G M E N T 

( R e v . 03/08   s w f )