ATTORNEY OR PARTY WITHOUT ATTORNEY (Name, State Bar number, and address): FOR COURT USE ONLY TELEPHONE NO: E-MAIL ADDRESS (Optional): ATTORNEY FOR (Name): FAX NO. (Optional) SUPERIOR COURT OF CALIFORNIA, COUNTY OF MENDOCINO ADDRESS: CITY AND ZIP CODE: BRANCH NAME: CASE NUMBER: PETITIONER/PLAINTIFF: ___________________________________________ RESPONDENT/DEFENDANT: HEARING DATE: TIME: DEPT.: NOTICED MOTION REQUESTING ENTRY OF JUDGMENT AFTER DEFAULT AND SUPPORTING DECLARATION (Small Claims) I, , Plaintiff/Defendant in this action, declare that: (circle) (date) the parties stipulated that Defendant/Plaintiff perform pursuant to the 1. On terms of the agreement reached in mediation, copy attached. 2. Defendant/Plaintiff, , breached the agreement as follows: 3. On (date), I sent a copy of the document to Defendant/Plaintiff through regular mail to the address listed in the agreement. 4. Plaintiff/Defendant requests that the dismissal of this action be vacated and that the Court enter a judgment granting relief pursuant to the terms of the agreement and the breach as stated above. I declare under penalty of perjury that the foregoing is true and correct. Date: Signature of Plaintiff/Defendant, declarant MSC-102-local (new 0109) American LegalNet, Inc. www.FormsWorkflow.com