Affidavit Of Noncompliance (Eviction) {SC-5400VA}

SC-5400VA, 05/18 Affidavit Based on Noncompliance Eviction (Small Claims) 247799.24(3), Wisconsin Statutes This form shall not be modified. It may be supplemented with additional materials. Page 1 of 2 Enter the name of the county in which this case was filed. STATE OF WISCONSIN, CIRCUIT COURT, COUNTY Enter the Plaintiff( s ) name. Plaintiff(s): - vs - Defendant(s): Enter the Defendant( s ) name. Enter the case number. Affidavit Based on Noncompliance Eviction (Small Claims) Case No. UNDER OATH, I STATE: For 1, enter the date of the agreement and describe what the agreem ent required the parties to do. 1. The plaintiff(s) and the defendant(s) entered into a stipulation (Agreement) on [Date] . It was agreed that 2. The stipulation stated that if the defe ndant(s) did not comply with the terms of the agreement, the plaintiff(s) could file an Affi davit of Noncompliance (SC - 5400 V A/ V B ) without notifying the defendant(s), ask the court to vacate the dismissal, enter judgment of eviction against the defendant(s), and issue a writ of restitution (order to vacate) . For 3, state how the defendant(s) faile d to comply with the agreement. 3. The defendant(s) did not comply with the following term(s) of the agreement: missed a scheduled payment, which was due on [Date] . failed to vacate the premises by [Date] . Other: 4. I ask the court to vacate the dismissal , enter judgment for evicti on against the defendant(s) , and issue a writ of restitution (order to vacate) directing the defendant(s) to immediately vacat e the property. For 5, check 5A or 5B as agreed to in the stipulation. If 5B, complete 1 - 3 . 5. I ask the court to vacate the dismissal and A. s chedule a hearing to determine the amount of a money judgment against the defendant(s) or B. g rant a money judgment against the defendant(s) as follows: 1) Amount specified in the Stipulation: $ 2) Subtract amount of any payments made since the Stipulation: $ 3 ) TOTAL judgment amount: $ 4) Plus statutory costs and disbursements as determined by the clerk of court. American LegalNet, Inc. www.FormsWorkFlow.com SC-5400VA, 05/18 Affidavit Based on Noncompliance Eviction (Small Claims) 247799.24(3), Wisconsin Statutes This form shall not be modified. It may be supplemented with additional material. Page 2 of 2 STOP! Take this document to a No tary Public BEFORE you sign it. After you have been sworn by a Notary Public, sign and print your name and date the document in front of the Notary Public. Plaintiff Print or Type Name Date Have the Notary Public sign and date the document. State of County of Subscribed and sworn to before me on Notary Public/Court Official Name Printed or Typed My commission/term expires: After you have been sworn by a Notary Public, sign and print your name and date the document in front of the Notary Public. Plaintiff Print or Type Name D ate Have the Notary Public sign and date the document. State of County of Subscribed and sworn to before me on Notary Public/Court Official Name Printed or Typed My commission/term expires: PARTIES MUST ATTACH THE PROPOSED ORDER. American LegalNet, Inc. www.FormsWorkFlow.com