USE NOTE: Plaintiff must complete the Request and the Default Judgment before filing with the court.

REQUEST 

1. I request a default entry against 
 

 for failure to appear.

 
 

2. The claim against the defaulted party is for a sum certain or for a sum, which by computation can be made certain. I  
  Costs: $ 
 

  Attorney fee/Other: $ 
 

   

request judgment for:  Damages: $ 
 
Payments/Credits: $ - 
 

   

 Total judgment: $ 

 

 .

3. The amount requested for damages is not greater than the amount stated in the complaint.

4. The defaulted party is not an infant or incompetent person.

5. 
 
 
 

 It is unknown whether the defaulted party is in the military service.  
 The defaulted party is in the military but there has been notice of pendency of the action and adequate time and  
 
    opportunity to appear and defend has been provided. Attached, as appropriate, is a waiver of rights and protections   
    provided under the Servicemembers Civil Relief Act. Facts upon which this conclusion is based are: (Specify)

 The defaulted party is not in the military service.

6. This request is made on my personal knowledge and, if sworn as a witness, I can testify competently to the facts in 
 

this request.

I declare under the penalties of perjury that this request has been examined by me and that its contents are true to the best 
of my information, knowledge, and belief.

                                                                                                 

Plaintiff/Attorney signature

                     
                     
                     

Subscribed and sworn to before me on 
 
 
 
My commission expires on 
 
Notary public, State of Michigan, County of 

                     

Date

 

 

Deputy clerk/Notary public signature

 . 

Name (type or print)
 

 

 . 

 Acting in the County of 

 

 This notarial act was performed using an electronic notarization system or a remote electronic notarization platform.

 

 

 

 

 

 

 

 

 

 

 . 

 .

STATE OF MICHIGANJUDICIAL DISTRICTJUDICIAL CIRCUITDEFAULT REQUEST, ENTRY, AND JUDGMENT(SUM CERTAIN)CASE NO. and JUDGECourt addressCourt telephone no.Approved, SCAOForm MC 07a, Rev. 7/22MCL 32.517, MCL 600.2441, MCL 600.5759, MCL 600.6013, 50 USC 3931, MCR 2.603Page 1 of 2Distribute form to: Court PlaintiffAll other partiesPlaintiff’s name, address, and telephone no.vDefendant’s name, address, and telephone no.Plaintiff’s attorney, bar no., address, and telephone no.Defendant’s attorney, bar no., address, and telephone no.If personal service is made, this default judgment becomes a final judgment after 21 days unless a motion to set aside is 
filed.

 to 
 

 to 
 

 .

 .

 

 

 % from 
 

 % from 
 

 the statutory rate of                       
 

 the statutory 6-month rate(s) of  

   

   

This judgment will earn interest at statutory rates, computed from the filing date of the complaint.

Judgment interest accrued thus far is $ 

 and is based on: If needed, attach separate sheet.

 

                     

Court clerk signature and date

                                          IT IS ORDERED this judgment is granted in favor of the plaintiff(s) as follows:
DEFAULT JUDGMENT

*Attach bill of costs if statutory limit is exceeded.

Damages: $ 
 

Total judgment: $ 

 

 Costs: $ 
 

  Attorney fee/Other: $ 
 

  Payments/Credits: $ - 
 

Default Request, Entry, and Judgment (Sum Certain) 
Page 2 of 2

(7/22) 

Case No. 
 

DEFAULT ENTRY
                                         The default of the party named above for failure to appear is entered.

                     

 
                                           

Court clerk/Judge signature and date

                      

Use  note:  The  party  who  sought  the  default  and 
default  judgment  is  responsible  for  serving  all  parties  in 
accordance with MCR 2.603(A)(2) and MCR 2.603(B)(4).

CERTIFICATE OF MAILING

I served a copy of this default request, entry, and judgment on the parties or their attorneys by first-class mail addressed 
to their last-known addresses as defined by MCR 2.107(C)(3). I declare under the penalties of perjury that this certificate 
of mailing has been examined by me and that its contents are true to the best of my information, knowledge, and belief.

Date

                                                       

Signature