Form B-1037 (Rev. 8/98) Attorney or Party Name, Address, Telephone & FAX Numbers, and California State Bar Number 1998 USBC, Central District of California FOR COURT USE ONLY Attorney for: __________________________________________ UNITED STATES BANKRUPTCY COURT CENTRAL DISTRICT OF CALIFORNIA In re CASE NO.: Debtor. ADVERSARY NO.: Plaintiff(s) vs. AFFIDAVIT AND REQUEST FOR ISSUANCE OF WRIT OF EXECUTION Defendant(s). STATE OF CALIFORNIA, COUNTY OF ___________________________________________________________________________ I, _________________________________________________________________________ hereby state under penalty of perjury that, 1. Judgment for $_______________________________ was entered on ____________________________________________ (date) in the docket of the above-entitled action in favor of: ____________________________________________________________________________________________________ as Judgment Creditor, and against ____________________________________________________________________________________________________ as Judgment Debtor (If registered Judgment, fill in below) Said Judgment was registered herein under Title 28, U.S. Code, Section 1963, being a Judgment which was obtained in Case No. ________________________________________ in the United States Bankruptcy Court, Central District of California and which has become FINAL. 2. I am the Judgment Creditor, or the attorney for said Judgement Creditor, and request issuance of a Writ of Execution on the Judgment. ACCRUED since the entry of judgment are the following sums: $__________________________________________ accrued interest, computed at _________________% (see note) $__________________________________________ accrued costs (Page 1 of 2) 3. Form B-1037 (Rev. 8/98) 1998 USBC, Central District of California In re: Debtor. CASE NO.: ADVERSARY NO.: Credit must be given for payments and partial satisfaction in the amount of $____________________________ which is to be credited against the total accrued costs and accrued interest, with any excess credited against the judgment as entered. I declare under penalty of perjury that the foregoing is true and correct. Executed at _____________________________________________________________, State of California, this _________________ day of ________________________________________, ____________. (year) ___________________________________________________ Signature NOTE: Judgments registered under 28 U.S.C. 1963 bear the rate of interest of the District of origin. (Page 2 of 2)