Reserved for Clerk’s File Stamp
NAME, ADDRESS, AND TELEPHONE NUMBER OF PARTY:
SUPERIOR COURT OF CALIFORNIA, COUNTY OF LOS ANGELES
SMALL CLAIMS
COURTHOUSE ADDRESS:
PLAINTIFF:
DEFENDANT:
CASE NUMBER:
DECLARATION OF JUDGMENT DEBTOR REGARDING
SATISFACTION OF JUDGMENT
1. I am the judgment debtor in this case.
2. Judgment was entered against me on ____________________________.
3. I have satisfied (paid) the judgment, as follows:
Fully, including accrued interest, costs and administrative fees, if applicable.
Partially in the amount of $__________.
The judgment creditor refuses to accept any more payments.
4.
I have requested that the judgment creditor file an acknowledgement of satisfaction of judgment. I made
my request
orally
in writing on (date) ___________. As of the date of this declaration, the judgment
creditor has failed or refused to comply with my request.
I have been unable to contact the judgment creditor because his/her present address is unknown.
5. The following document(s), which constitutes evidence of
full
partial payment of the judgment is
attached:
Cancelled
check
money order written by me after judgment and made payable to, and endorsed by,
the judgment creditor.
Cash, receipt for the amount paid, signed by the judgment creditor.
Other: _____________________________________________________________________.
I declare under penalty of perjury, under the laws of the State of California,
that the foregoing is true and correct.
TYPE OR PRINT JUDGMENT DEBTOR’S NAME
DATE
SIGNATURE OF JUDGMENT DEBTOR
NOTE: THIS DOCUMENT IS NOT INTENDED FOR USE BY THE COUNTY RECORDER’S OFFICE.
CLERK’S NOTATION OF ENTRY OF SATISFACTION
Satisfaction of judgment entered in register of action pursuant to Code Civ. Proc., § 116.850, subdivision (c) as follows:
Full Satisfaction.
Partial Satisfaction in the amount of $____________________.
Clerk’s Certificate of Satisfaction of Judgment (LACIV 040) issued.
SHERRI R. CARTER, Executive Officer/Clerk
Date:
By:
, Deputy
SCLA 003 (Rev. 12/14)
Code Civ. Proc., § 116.850(c)
DECLARATION OF JUDGMENT DEBTOR REGARDING
LASC Approved 12/08
SATISFACTION OF JUDGMENT
For Optional Use
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