FORM 4

AN CHÚIRT CHUARDA
THE CIRCUIT COURT


CIRCUIT                                                                                                                          COUNTY OF
 

CONSENT TO JUDGMENT

BETWEEN
......................…………. Plaintiff
AND
............…………………. Defendant

The Defendant hereby admits that he is liable to the Plaintiff for the sum of ... or being a portion of the Claim in ...................... as claimed in the Civil Bill served upon him on ......., and consents to the entry of judgment against him accordingly with appropriate costs to date.
 

Dated this .... day of ....... .

Signed ...................
Defendant/Solicitors for the Defendant 

Witness …………................ (if appropriate):