Certification Of Proof - Superior Court Of New Jersey Page 6
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NOTICE: This is a public document, which means the document as submitted will be available to the public upon request. Therefore,
do not enter personal identifiers on it, such as Social Security number, driver’s license number, vehicle plate number, insurance policy
number, active financial account number, or active credit card number.
Name
NJ Attorney ID Number
Address
Daytime Telephone
Superior Court of New Jersey
Law Division
County
Docket Number:
Plaintiff(s)
v.
Certification of Proof
Defendant(s)
1.
, being duly sworn upon his/her oath deposes and says:
2. I am fully familiar with all of the facts and all of the proceedings in the above matter.
3. The defendant/debtor is not a minor and is not a mentally incapacitated person.
4. The defendant/debtor’s address is
, and I am
aware that the defendant’s/debtor’s address or business location is at this location because:
(state why and provide the source of your knowledge)
5. I am aware that the defendant(s) / debtor(s) (for individuals only) in the above matter
is
is not
on active duty in the military service of the United States at the present time because:
(state why and provide the source of your knowledge)
6. The defendant(s)/debtor(s) owes the total amount of $
. This amount is based upon the following, after
giving the defendant(s) all the credits due:
a) Principal amount due $
, pre-judgment interest (where applicable) in the amount of
$
, the date of the defendant’s breach was
, and the document of obligation that
provides for the rate of pre-judgment interest is attached.
b) Court costs in the amount of $
.
7. This is not a repossession case.
I have attached/ the documentation to support the entry of this default judgment.
I certify that the foregoing statements made by me are true. If any of the foregoing statements made by me are false, I am
subject to punishment.
Date
Signature
Print Name
Revised 04/18/2017, CN 10914 (How to Request a Default Judgment)
page 6 of 6
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