Free Request for Default - Oregon

IN THE CIRCUIT COURT OF THE STATE OF OREGON FOR THE THIRD JUDICIAL DISTRICT Small Claims Division - P.O. Box 12869, Salem, OR 97309 _________________________________, Plaintiff, vs. _________________________________, , Defendant(s). ) ) ) ) ) ) ) ) REQUEST FOR DEFAULT JUDGMENT; DEFENDANT STATUS AFFIDAVIT Case No. _________________________

(NOTE: Complete this and attach a completed Judgment you propose) I, _________________________ request default judgment against ______________________ for the following: (your name) (other party's name) A total judgment award of $_____________, which total includes: 1. A money award of $____________, 4. Costs and service expenses of $__________, 2. Prejudgment interest of $___________, 5. A prevailing party fee under ORS 20.190 of $85. 3. Accrued arrearages of $__________, if any, I request judgment include postjudgment interest at the rate of 9% per annum (or) _______ % per ___________ based on _______________________________________________________________________. (authority for interest) And, I request the following terms in addition to or in lieu of a money award: NONE, or _________________ ___________________________________________________________________________________________ I have attached a completed proposed small claims judgment for purposes of this request. In furtherance of this request and being duly sworn, I state that: 1. The above-named defendant(s) was duly and regularly served with a copy of the claim, failed to pay the claim or demand a hearing or trial, and at least 14 days have passed from the date of service; 2. No person against whom I seek judgment by this request is, to the best of my knowledge and belief, one of the following defined by ORS 125.005 and protected by ORCP 69B: a minor, incapacitated, a protected person, or a respondent for whom entry of a protective order is sought under ORS 125.055. 3. I have filled out and attached a Supplemental Affidavit regarding Defendant's status under the Servicemembers Civil Relief Act. DATED: ____________ ________________________________ Plaintiff's Name (print) __________________________________ Authorized Signature

SUBSCRIBED AND SWORN to before me this __________day of ____________________, 200_____. NOTARY PUBLIC FOR OREGON/DEPUTY COURT ADMINISTRATOR My Commission expires: ___________________________________________

REQUEST FOR DEFAULT JUDGMENT; DEFENDANT STATUS AFFIDAVIT - Page 1 of 1

FC(10/9/07)