Affidavit In Support Of Application For Entry Of Fact Of Default Page 3

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Revised 3/2005
Suggested Form D100
UNITED STATES BANKRUPTCY COURT
WESTERN DISTRICT OF NEW YORK
In Re:
AFFIDAVIT IN SUPPORT OF
APPLICATION FOR ENTRY
OF FACT OF DEFAULT
Debtor(s).
[Bankruptcy Rule 7055(a)]
BK Case No. ____________
Plaintiff(s),
AP Case No. ____________
vs.
Defendant(s).
The undersigned, being duly sworn, deposes and states that:
1.
I am an attorney admitted to practice before this Court and am the attorney to the Plaintiff
in this action (or, in the alternative, I am the Plaintiff in the above captioned Adversary
Proceeding and appear pro se).
2.
I make this Affidavit in support of Plaintiff’s request that the Clerk of Court certify and
enter the “Fact of Default” of Defendant,______________________________________,
(“Defendant”), pursuant to Federal Rules of Bankruptcy Procedure (“Bankruptcy Rule”)
7055(a).
3.
This Adversary Proceeding is a
Core
Non-Core Proceeding (check appropriate
box).
4.
On _________________, 2_____, a copy of the Summons and Complaint was served on
Defendant pursuant to Bankruptcy Rule 7004.
5.
A Certificate of Service detailing the date, time and manner of service on Defendant was
filed with the Court on _________________, 2_____.
6.
Defendant has failed to answer, plead or otherwise defend this action.
Page 1

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