Reserved for Clerk's File Stamp ATTORNEY OR PARTY WITHOUT ATTORNEY (Name, address, telephone number, and attorney State Bar number): ATTORNEY FOR (Name): SUPERIOR COURT OF CALIFORNIA, COUNTY OF ALAMEDA COURT ADDRESS PLAINTIFF DEFENDANT CASE NUMBER DECLARATION REGARDING DAMAGES FOR DEFAULT JUDGMENT — UNLAWFUL DETAINER 1. I am the plaintiff plaintiff's attorney plaintiff's agent other (specify): 2. Total back rent stated in notice to pay rent or quit: From (date): To (date): at $ per month (less payments in the amount of $ made prior to the notice): 3. Additional rental value claimed for occupancy after the period stated in the notice to pay rent or quit: (Claim may not go beyond date of hearing.) For the period beginning (date): and ending (date): at $ per 4. Other damages, pleaded and proved: 5. Subtotal: 6. Less: a. Deposits: $ b. Payment(s) made after notice to pay rent or quit: $ c. Total credits: 7. Balance due: (May not exceed prayer or amount claimed in Request for Entry of Default.) 8. Attorney fees, if prayed for and provided for in written agreement (minimum fee of $300 for unlawful detainer cases, per court schedule): 9. Cost, per memorandum of costs: 10. Did defendant pay any deposits that are not being credited above? reasons why they should not be credited: 11. Is the defendant still occupying the premises? Yes Yes $ $ $ $ $ $ $ $ No. If yes, specify amounts and No. If no, specify date when defendant vacated: I declare under penalty of perjury, under the laws of the State of California, that the foregoing is true and correct. DATE FORM NO. AC-010 (New 4-00) TYPE OR PRINT DECLARANT'S NAME DECLARANT'S SIGNATURE DECLARATION REGARDING DAMAGES FOR DEFAULT JUDGMENT — UNLAWFUL DETAINER AL-021 2002 © American LegalNet, Inc.