This form contains 40 fields organized into 17 sections. Below is a complete list of every field, its type, and what information is expected.

Field Name Type Description
Applicant signature and bar no.
Applicant/Attorney signature Text
Enter the applicant's or attorney's handwritten signature (or typed name if allowed) to attest to the statements in this affidavit.
Bar number Text
Enter the attorney's state bar number; if the applicant is not an attorney, leave this field blank or enter 'N/A' as instructed.
Case Number and Judge
Case Number Text
Enter the court-assigned case number for this matter exactly as shown on court documents (include any letters, dashes, or suffixes).
Presiding Judge Text
Enter the full name or official designation of the judge assigned to the case (e.g., Judge Jane Q. Smith).
Certificate of Mailing - Date and Signature
Certificate of Mailing — Date Date
Enter the date when the certificate of mailing was completed.
Certificate of Mailing — Signature Text
Enter the name/signature of the person who served the mailing and is certifying under penalty of perjury.
Court address and phone
Court address Text
Enter the full mailing address of the court handling this case, including street address, city, state, and ZIP code.
Court telephone number Text
Enter the court's primary telephone number where staff or the clerk can be reached regarding this case.
Court Jurisdiction
Judicial District Text
Enter the judicial district where the case is filed (provide the district name or number as it appears on official court documents).
Judicial Circuit Text
Enter the judicial circuit where the case is filed (provide the circuit name or number as it appears on official court documents).
Default entered (1a) details
1a - Default was entered against me Checkbox
Check this box when a default has been entered against you on the date you will enter on the line (i.e., you did not respond and the court entered a default).
Default entered date (1a) Date
Enter the date on which the default was entered against you. Fill only if '1a - Default was entered against me' is 'Yes'.
Depends on: 1a - Default was entered against me
1a - for failure to answer Checkbox
Check this box when the default was entered because you failed to file an answer to the complaint. Fill only if '1a - Default was entered against me' is 'Yes'.
Depends on: 1a - Default was entered against me
1a - for failure to appear Checkbox
Check this box when the default was entered because you failed to appear (did not appear at a required hearing or court appearance). Fill only if '1a - Default was entered against me' is 'Yes'.
Depends on: 1a - Default was entered against me
Default judgment entered (1b) details
1b. Default judgment was entered against me Checkbox
Check this box when a default judgment was entered against you (enter the date on the line) and you are asserting the form's subsection 1b (that 21 days have not yet passed since that default judgment date).
Default judgment entered date (1b) Date
Enter the date when the default judgment was entered against you for the case item described in 1b. Fill only if '1b. Default judgment was entered against me' is 'Yes'.
Depends on: 1b. Default judgment was entered against me
1b — for failure to answer Checkbox
Check this box when the default judgment referenced in 1b was entered because you failed to answer the complaint. Fill only if '1b. Default judgment was entered against me' is 'Yes'.
Depends on: 1b. Default judgment was entered against me
1b — for failure to appear Checkbox
Check this box when the default judgment referenced in 1b was entered because you failed to appear. Fill only if '1b. Default judgment was entered against me' is 'Yes'.
Depends on: 1b. Default judgment was entered against me
Default judgment/service (1c)
1c. 21 days has passed since the default judgment was entered, but I was not personally served the summons and complaint Checkbox
Check this box if 21 days have passed since a default judgment was entered against you and you were not personally served with the summons and complaint. Fill only if '1b. Default judgment was entered against me' is 'Yes'.
Depends on: 1b. Default judgment was entered against me
Defendant Info
Defendant name, address, and telephone Text
Enter the defendant’s full name followed by their complete mailing address and a daytime telephone number (include street, city, state, and ZIP).
Defendant attorney, bar number, address, and telephone Text
Enter the defendant attorney’s full name, bar number, complete business address, and a daytime telephone number for the attorney.
General
Form Instructions Button
Hearing Date and Location
Hearing date and time Text
Enter the scheduled date and start time of the hearing as set by the court (e.g., 06/15/2025 at 9:30 AM).
Hearing location Text
Enter the full location where the hearing will be held (for example, courthouse name, room or department, and address or courtroom number).
Judge and Bar Number
Judge Name Text
Enter the full name of the judge who will hear the motion as shown after 'before Hon.' on the form.
Bar Number Text
Enter the state bar number associated with the attorney (or the judge's bar number if requested) exactly as it should appear on the form.
Jurisdiction and reason for failure (2a/2b)
2a. The court lacks jurisdiction because I was not served with the summons and complaint Checkbox
Check this box if you are claiming the court lacks jurisdiction over you because you were not personally served with the summons and complaint.
2b. I have good cause for my failure to appear/answer Checkbox
Check this box if you are claiming good cause for failing to appear or answer and you will state the reason (and attach a separate sheet if needed) and describe your meritorious defense.
2b. Reason for failure to appear/answer Text
Briefly describe the reason you did not appear or answer in this case, providing the facts or circumstances that explain your failure to appear/answer (attach a separate sheet if needed). Fill only if '2b. I have good cause for my failure to appear/answer' is 'Yes'.
Depends on: 2b. I have good cause for my failure to appear/answer
Meritorious defense
Meritorious defense – description Text
Briefly state your meritorious (valid) defense to the claim, describing the specific facts or legal reasons why the default judgment should be set aside. Fill only if '2b. I have good cause for my failure to appear/answer' is 'Yes'.
Depends on: 2b. I have good cause for my failure to appear/answer
Notarial jurisdiction and electronic notarization
Notary county Text
Enter the name of the county in Michigan where the notary public's commission is held or where the notarization took place.
Notary — Acting in the County of Checkbox
Check this box when the notary public is certifying that they are acting in the (named) county on the notarial certificate.
Acting in county Text
Enter the name of the county in which the notary is acting for this notarization if it is different from the notary's commission county; leave blank if the same county.
Electronic notarization performed Checkbox
Check this box when the notarial act was performed using an electronic notarization system or a remote electronic notarization platform.
Notary/subscribed date and deputy signature
Subscribed/Sworn Date Date
Enter the date when the affidavit was subscribed and sworn before the notary public or deputy clerk.
Deputy Clerk / Notary Signature Text
Type the signature or printed name of the deputy clerk or notary public who signed the form.
Commission Expiration Date Date
Provide the expiration date of the notary public's commission.
Name (type or print) Text
Enter the notary public's or deputy clerk's name in clear, printed or typed form.
Plaintiff Info
Plaintiff name, address, and telephone Text
Enter the plaintiff’s full name followed by their complete mailing address and a contact telephone number.
Plaintiff attorney, bar number, address, and telephone Text
Enter the plaintiff attorney’s full name, state bar number, complete mailing address, and a contact telephone number.