"Request Form for Judgment and Reply to Admission"

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Names of attorney(s)
1
Firm's name and addresss
2
3
[Name of the Court]
4
)
Case No.: No. [case number]
5
Plaintiff name(s),
)
[Request for Judgment and Reply to
)
6
Plaintiff,
Admission]
)
)
7
vs.
)
)
Defendant name(s),
8
)
)
9
Defendant
)
10
11
1. The Defendant’s date of birth is:
a.
Date: ________________________
12
b.
Unknown
13
2. Judgment Amount Sought
14
a. Initial amount: _______________________
b. Interest: ____________________ Rate_______% Period______________
15
c. Court Fees: __________________________
d. Total Sought: ________________________
16
3. Defendant’s Payment Plan
17
a.
The Defendant has offered a payment plan and I accept the proposal.
b.
18
The Defendant has offered a payment plan and I do not accept the
proposal.
19
c.
The Defendant has not offered a payment plan.
4. Plaintiff’s Payment Plan
20
Total Amount Sought: _______________________
21
a.
I would like the Defendant to pay immediately
b.
22
I would like the Defendant to pay by _______________________
c.
I would like the Defendant to pay in _______________________
23
installments of ______________________.
24
5. Admission or Defense
a.
The Defendant has not filed admission or defense to this claim.
25
b.
The Defendant admits to the money owed in this claim.
26
I certify that the information given above is true and factual to the best of my
27
knowledge.
28
Signature: __________________________________
Date: _________________
[Pleading title summary] - 1
Names of attorney(s)
1
Firm's name and addresss
2
3
[Name of the Court]
4
)
Case No.: No. [case number]
5
Plaintiff name(s),
)
[Request for Judgment and Reply to
)
6
Plaintiff,
Admission]
)
)
7
vs.
)
)
Defendant name(s),
8
)
)
9
Defendant
)
10
11
1. The Defendant’s date of birth is:
a.
Date: ________________________
12
b.
Unknown
13
2. Judgment Amount Sought
14
a. Initial amount: _______________________
b. Interest: ____________________ Rate_______% Period______________
15
c. Court Fees: __________________________
d. Total Sought: ________________________
16
3. Defendant’s Payment Plan
17
a.
The Defendant has offered a payment plan and I accept the proposal.
b.
18
The Defendant has offered a payment plan and I do not accept the
proposal.
19
c.
The Defendant has not offered a payment plan.
4. Plaintiff’s Payment Plan
20
Total Amount Sought: _______________________
21
a.
I would like the Defendant to pay immediately
b.
22
I would like the Defendant to pay by _______________________
c.
I would like the Defendant to pay in _______________________
23
installments of ______________________.
24
5. Admission or Defense
a.
The Defendant has not filed admission or defense to this claim.
25
b.
The Defendant admits to the money owed in this claim.
26
I certify that the information given above is true and factual to the best of my
27
knowledge.
28
Signature: __________________________________
Date: _________________
[Pleading title summary] - 1