Name and Address of Court: SMALL CLAIMS CASE NO. PLAINTIFF/DEMANDANTE (Name, address, and telephone number of each): DEFENDANT/DEMANDADO (Name, address, and telephone number of each): Telephone No.: Telephone No.: Telephone No.: Telephone No.: See attached sheet for additional plaintiffs and defendants. REQUEST TO PAY JUDGMENT IN INSTALLMENTS 1. I request the court to allow me to make installment payments on the judgment entered against me in this case in the amount and manner stated below. 2. My request is based on this declaration, the court records, my completed financial declaration (Form EJ-165—obtain from court clerk) attached to this declaration, and any other evidence that may be presented. NOTE: YOU MUST ATTACH A COMPLETED FINANCIAL DECLARATION WITH THIS REQUEST TO MAKE INSTALLMENT PAYMENTS. 3. Judgment was entered against me in this matter on (date): in the amount of (specify): $ 4. Payment of the entire amount of the judgment at one time will be a hardship on me because (specify): 5. I can and will make payments toward the judgment in the amount of (specify): $ month. per week 6. I request the court to order that I make payments as specified in item 5 and that execution on the judgment be stayed as long as I make payments according to this schedule. I declare under penalty of perjury under the laws of the State of California that the foregoing is true and correct. Date: .............................................. (SIGNATURE OF JUDGMENT DEBTOR) (TYPE OR PRINT NAME) NOTICE TO JUDGMENT CREDITOR The judgment debtor has requested the court to allow payment of the judgment in installments. Complete the following and return this form to the court within 10 days. You will be notified of the court's order, or, if a hearing is necessary, the date of the hearing. 1. I am the judgment creditor, and I have read and considered the judgment debtor's request to make installment payments on the judgment. I am willing to accept the payment schedule the judgment debtor has requested. 2. a. week per month. b. I am willing to accept payments in the amount of (specify): $ c. I am opposed to accepting installment payments because (specify): I declare under penalty of perjury under the laws of the State of California that the foregoing is true and correct. Date: .............................................. (SIGNATURE OF JUDGMENT CREDITOR) (TYPE OR PRINT NAME) SEE REVERSE FOR HEARING DATE, IF ANY. (Continued on reverse) Form Approved by the Judicial Council of California SC-106 [New January 1, 1992] REQUEST TO PAY JUDGMENT IN INSTALLMENTS (Small Claims) Code of Civil Procedure, § 116.620(b) 2001 © American LegalNet, Inc. NOTICE OF MOTION A hearing will be held on this request as follows: DATE HEARING DATE TIME PLACE 1. FECHA DEL JUICIO DAY 3. 4. 2. COURT ORDER 1. 2. 3. The judgment debtor shall pay the full amount of the judgment immediately. The judgment debtor may pay the judgment as follows: a. (If initial lump sum ordered) Pay $ on (date): b. Pay $ or more on (specify): of every (specify): until the judgment is fully paid. (Missed payments) On the filing of an affidavit or declaration by the judgment creditor showing that any payment due has not been paid, this order shall be set aside and the clerk may issue a writ of execution immediately, without further order of the court. Date: (JUDGE OR COMMISSIONER) WARNING: IF YOU MISS A PAYMENT, THE BALANCE OWING ON THE JUDGMENT WILL BECOME DUE IMMEDIATELY. CLERK'S CERTIFICATE OF MAILING—NOTICE TO JUDGMENT CREDITOR I certify that I am not a party to this action. This Notice to Judgment Creditor was mailed first class, postage prepaid, in a sealed envelope to the responding party at the address shown on the reverse. The mailing and this certification occurred , California, at (place): on (date): Clerk, by , Deputy CLERK'S CERTIFICATE OF MAILING — NOTICE OF MOTION I certify that I am not a party to this action. This Notice of Motion was mailed first class, postage prepaid, in a sealed envelope to the responding party at the address shown on the reverse. The mailing and this certification occurred , California, at (place): on (date): Clerk, by , Deputy CLERK'S CERTIFICATE OF MAILING — COURT ORDER I certify that I am not a party to this action. This Court Order was mailed first class, postage prepaid, in a sealed envelope to the responding party at the address shown on the reverse. The mailing and this certification occurred at (place): , California, on (date): Clerk, by SC-106 [New January 1, 1992] REQUEST TO PAY JUDGMENT IN INSTALLMENTS (Small Claims) , Deputy Page two 2001 © American LegalNet, Inc.