This form contains 28 fields organized into 14 sections. Below is a complete list of every field, its type, and what information is expected.

Field Name Type Description
Applicant/Attorney Signature and Date
Applicant/Attorney Signature Text
Enter the signature of the applicant or the applicant’s attorney to certify the request.
Date Signed Date
Enter the date on which the applicant or attorney signed this request.
Approved, SCAO
Judicial District Text
Enter the judicial district for the court handling this case.
Judicial Circuit Text
Enter the judicial circuit for the court handling this case.
Case Number Text
Case Number and Judge Text
Enter the court case number and the name of the judge assigned to this case.
Case and Court Information
Case Number and Judge Text
Enter the court case number and the name of the judge assigned to the case.
Court Address Text
Enter the full mailing address of the court handling this case.
Court Telephone Number Text
Enter the phone number for the court handling this case.
CERTIFICATE OF MAILING
Mailing Certificate Date Date
Enter the date you completed the certificate of mailing.
Signature Text
Provide the signature of the person certifying that the document was mailed.
DEFAULT ENTRY
Court Clerk Signature and Date Text
Enter the court clerk’s signature and the date the default entry is signed/entered.
Defendant Information
Defendant Name, Address, and Telephone Text
Enter the defendant’s full name along with their mailing address and telephone number.
Defendant Attorney Contact and Bar Number Text
Enter the defendant’s attorney’s name, bar number, address, and telephone number.
Electronic/Remote Notarization Indicator
Acting in the County of Checkbox
Check this box if the notarization was performed electronically/remotely and the notary is acting in the Michigan county you enter on the line next to this checkbox.
Military Service Facts (If Applicable)
Military Service Facts Text
Provide the facts and details supporting the selected statement about whether the defaulted party is in the military service. Fill only if 'In military service (notice given and time to appear provided)' is 'Yes'.
Depends on: In military service (notice given and time to appear provided)
Military Service Status (Select One)
Unknown whether in military service Checkbox
Check this box if it is unknown whether the defaulted party is in the military service.
Not in military service Checkbox
Check this box if the defaulted party is not in the military service.
In military service (notice given and time to appear provided) Checkbox
Check this box if the defaulted party is in the military but has been given notice of the pending action and adequate time and opportunity to appear and defend.
Notary Commission Expiration
Notary commission expiration date Date
Enter the date on which the notary public’s commission expires.
Notary Jurisdiction (Counties)
Notary County Text
Enter the Michigan county where you are commissioned as a notary public.
Acting in the County of Checkbox
Check this box if you are the notary public and you are acting in the county written on the line next to this text.
Acting In County Text
Enter the Michigan county in which you are performing the notarization. Fill only if 'Acting in the County of' is 'Yes'.
Depends on: Acting in the County of
Notary/Clerk Certification and Signatures
Deputy Clerk/Notary Public Signature Text
Enter the signature of the deputy clerk or notary public who is certifying the oath.
Deputy Clerk/Notary Public Printed Name Text
Enter the deputy clerk or notary public’s name as typed or printed.
Party in Default
Party in Default Text
Enter the name of the party against whom default is being requested (as listed in the case).
Plaintiff Information
Plaintiff contact information Text
Enter the plaintiff’s full name, mailing address, and telephone number.
Plaintiff attorney information Text
Enter the plaintiff’s attorney’s name, bar number, mailing address, and telephone number.