COMMONWEALTH OF MASSACHUSETTS DISTRICT COURT DEPARTMENT
DIVISION DOCKET NO.
________________________________________________________________ v. ________________________________________________________________
REQUEST FOR DEFAULT
(Rule 55 (a))
I, __________________________________________________________ the undersigned, for the above-named plaintiff(s) ____________________________________________, state that the complaint in this action was filed on __________________, and the summons and a copy of the complaint were served on defendant(s) ______________________________________ on _______________________, as appears from the officer's return; and that the defendant(s) herein has (have) failed to serve a responsive pleading or to otherwise defend as provided by rule. Therefore, I request that default be entered against defendant(s) _______________________________________________ in this action. Signed under the penalties of perjury.
Signature_____________________________________________ Name_________________________________________________ Address_______________________________________________
DATE
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Telephone _____________________________________________