CR-111/JV-791 ATTORNEY OR PARTY WITHOUT ATTORNEY (Name, address, and State Bar number): After recording, return to: TEL NO.: E-MAIL ADDRESS (Optional): ATTORNEY FOR FAX NO. (optional): JUDGMENT CREDITOR ASSIGNEE OF RECORD SUPERIOR COURT OF CALIFORNIA, COUNTY OF STREET ADDRESS: MAILING ADDRESS: CITY AND ZIP CODE: BRANCH NAME: FOR RECORDER'S USE ONLY CASE NUMBER: CASE NAME: ABSTRACT OF JUDGMENT--RESTITUTION Amended FOR COURT USE ONLY 1. The judgment creditor assignee of record other (specify): applies for an abstract of judgment and represents the following: a. Judgment debtor's Name and last known address b. c. d. Driver's license no. [last 4 digits] and state: Social security no. [last 4 digits]: Date of birth: Unknown Unknown Unknown Date: (SIGNATURE OF APPLICANT OR ATTORNEY) ON INFORMATION AND BELIEF (TYPE OR PRINT NAME) Page 1 of 2 Form Approved for Optional Use Judicial Council of California CR-111/JV-791 [Rev. July 1, 2015] ABSTRACT OF JUDGMENT--RESTITUTION Penal Code, §§ 1202.4(i), (m), 1214; Welfare and Institutions Code, § 730.6(i), (r); Code of Civil Procedure, § 674 www.courts.ca.gov American LegalNet, Inc. www.FormsWorkFlow.com CR-111/JV-791 CASE NAME: CASE NUMBER: CERTIFICATION [SEAL] 2. I certify that the following is a true and correct judgment entered in this action. 3. Judgment creditor (name): whose address or whose attorney's address appears on this form above the court's name. 4. Judgment debtor (full name as it appears in judgment): 5. Judgment entered on (date): 6. Total amount of judgment as entered or last renewed: $ 7. A stay of enforcement was ordered on: A stay of enforcement was not ordered. and is effective until: This abstract of judgment was issued on (date): Clerk, by , Deputy Page 2 of 2 CR-111/JV-791 [Rev. July 1, 2015] ABSTRACT OF JUDGMENT--RESTITUTION American LegalNet, Inc. www.FormsWorkFlow.com