FORM 10
AN CHÚIRT CHUARDA
THE CIRCUIT COURT
CIRCUIT COUNTY OF
REQUEST FOR JUDGMENT BY DEFAULT OF DEFENCE
BETWEEN
...............……. Plaintiff
AND
.......…………….
The Plaintiff refers to the Civil Bill issued herein on the ........ and served herein on the ................... An Appearance having been entered by the Defendant on the ................, but no Defence having been delivered by the Defendant the Plaintiff hereby requests that judgment be entered for ........... being the sum now actually due over all just credits and allowances (or the goods and chattels withheld by the Defendant) as verified by the affidavit sworn by .................., together with Costs.
CERTIFICATE
It is hereby certified that the sum of .... only/no sum whatsoever has been paid on foot of the claim herein since service of the Civil Bill herein and that the sum of .... is now actually due by the Defendant to the Plaintiff.
Dated the ...... day of ..........
Signed ........…………...............
Plaintiff/Solicitor for the Plaintiff
To: ................….……..........
The Defendant/Solicitor for the Defendant
and
To: The County Registrar