COMMONWEALTH OF MASSACHUSETTS

 ,SS:

 HOUSING COURT DEPARTMENT
 DIVISION 

CIVIL ACTION 
NO. / / /- / / / / / / 

__________________________ 
Plaintiff 

VS. 

__________________________ 
Defendant 

REQUEST FOR DEFAULT UNDER RULE 55(A) 

The undersigned hereby states under the penalties of
perjury, that the defendant ______________________________was
duly served with summons and complaint on ______________________,
as appears from the officer’s return, that the time to serve answer
or other responsive pleading has expired under MRCP 12(a)(1), and
the defendant has not served any answer or responsive pleading, and
has  not  filed  any  pleading  in  court;  wherefore,  application  is
hereby made that the defendant be defaulted. 

___________________________________ 
Signed under the penalties of perjury
Name: _____________________________ 

Address: __________________________ 

___________________________________ 

Telephone: ________________________ 

Date: _____________________________ 

NOTICE OF ENTRY OF DEFAULT UNDER RULE 55 (a) 

As provided by the Massachusetts Rules of Civil Procedure, the
defendant ________________________is defaulted for failure to plead
or otherwise defend, as shown by the foregoing affidavit. 

Judgment  for  the  amount  and  costs  due  will  entered  by  the
Clerk upon request and affidavit under Rule 55 (b)(1), or by the
court after assessment under Rule 55(b)(2), unless the default is
earlier set aside by the Court for cause shown under Rule 55(c). 

_______________________ 
Clerk-Magistrate