CourtofJustice RequestforClerk’sOrderonConsent Form11.2AOnt.Reg.No.:258/98 SmallClaimsCourt ClaimNo. PlaintiffNo.1Lastname,ornamepanyFirstNameAddress(streetnumber,apt.,unit)City/TownPostalCodeRepresentativeAddress(streetnumber,apt.,unit)City/TownPostalCodeDefendantNo.1Lastname,ornamepanyFirstNameAddress(streetnumber,apt.,unit)City/TownPostalCodeRepresentativeAddress(streetnumber,apt.,unit)City/TownPostalCode AddressPhoneNumber SecondNameProvince Province SecondNameProvince Province Additionalplaintiff(s)listedonattachedForm1A.AlsoKnownas Phoneno.Faxno.LSUC# Phoneno.Faxno.Additionaldefendant(s)listedonattachedForm1A.AlsoKnownas Phoneno.Faxno.LSUCno. Phoneno.Faxno. NOTE: Thisrequestmustbesignedbyallpartiesandanyonebeingadded,deletedorsubstituted. Lesformulesdestribunauxsontaffichéesenanglaisetenfrançaissurlesitewww.ontariocourtforms.on.ca.Visitezcesitepourdesrenseignementssurdesformatsessibles. RSCC-11-2A-E(2014/01) FORM11.2A PAGE2 ClaimNo. TOTHEPARTIESTHISREQUESTISFILLEDBY: Istatethat:Eachpartyhasreceivedacopyofthisform. (Nameofparty) Nopartythatwouldbeaffectedbytheorderisunderdisability. Thisformhasbeensignedandconsentedtobyallparties,includinganypartiestobeadded,deletedorsubstituted. Irequestthattheclerkmakethefollowingorder(s)ontheconsentofallparties:(Checkappropriateboxes). setasidethenotingindefaultof(Nameofdefendant(s)) setasideDefaultJudgementagainst(Nameofdefendant(s)) restoretothelistthefollowingmatterthatwasdismissedunderRule11.1:(Specify.) canceltheexaminationhearingregarding(Nameofpersontobeexamined) withrespecttothefollowingstep(s)takentoenforcethedefaultjudgmentthatarenotpleted: withdrawtheWritofSeizureandSaleofLandissuedagainst:(Nameofdebtor(s)) anddirectedtothesheriffofthe : (Nameofcounty/regioninwhichthesheriff(enforcementoffice)islocated) (Provideinstructionsaboutwhatistobedonewithanyproceedsheldorpropertyseizedbythesheriff.) withdrawtheWritofSeizureandSaleofPersonalPropertyissuedagainst:(Nameofdebtor(s)) anddirectedtothesheriffofthe : (SmallClaimsCourtlocation) (Provideinstructionsaboutwhatistobedonewithanyproceedsheldbytheclerkofthecourtorprophecythathasbeenseizedbythebailiff.) RSCC-11-2A-E(2014/01) Continuedonnextpage FORM11.2A PAGE3 terminatetheNoticeofGarnishmentorNoticeofRenewalofGarnishmentissuedagainst: ClaimNo. (Nameofdebtor(s)) anddirectedto : (Nameofgarnishee) (Provideinstructionsaboutwhatistobedonewithanymoneyheldbytheclerkofthecourt.) notethatpaymenthasbeenmadeinfullsatisfactionofanorderortermsofsettlement dismissthe: Plaintiff'sClaim Defendant'sClaim costsintheamountof$ (Amount) ,tobepaidto (Nameofparty(ies)) by(Nameofparty(ies)) Theoriginallyscheduledtrialdateislessthan30daysawayandIrequestthattheclerkmakethefollowingorder(s)ontheconsentofallpartiesandanypersontobeaddedorsubstituted:(Checkappropriateboxes.) amendaPlaintiff’sClaimissuedon(Attachtwo(2)copiesoftheamendedPlaintiff’sClaim.) ,20 . amendadefencefiledon(Attachtwo(2)copiesoftheamendedDefence.) ,20 . amendaDefendant'sClaimissuedon(Attachtwo(2)copiesoftheamendedDefendant'sClaim.) ,20 . addtothe Plaintiff'sClaim (Nameofparty)Defendant'sClaim asa Defendant Plaintiff deletefromthe Plaintiff'sClaim Defendant'sClaim(Nameofparty) substitute with inthe Plaintiff'sClaim (Nameofparty) (Nameofparty)Defendant'sClaim RSCC-11-2A-E(2014/01) Continuedonnextpage FORM11.2A PAGE4 ,20(Signatureofpartyconsenting) (Nameofpartyconsenting)(Signatureofwitness)(Nameofwitness) ,20 (Signatureofpartyconsenting) (Nameofpartyconsenting) (Signatureofwitness) (Nameofwitness)DISPOSITION:Theclerkofthecourtpletethissection. ordertogoasaskedorderrefusedbecause: ClaimNo.,20 (Signatureofpartyconsenting)(Nameofpartyconsenting)(Signatureofwitness)(Nameofwitness),20 (Signatureofpartyconsenting)(Nameofpartyconsenting)(Signatureofwitness)(Nameofwitness) ,20 SaveForm PrintForm RSCC-11-2A-E(2014/01) (Signatureofclerk) ClearForm