ATTORNEY OR PARTY WITHOUT ATTORNEY (Name and Address) For Court Use Only TELEPHONE NO: ATTORNEY FOR (Name) SUPERIOR COURT OF CALIFORNIA, COUNTY OF EL DORADO STREET ADDRESS: 3321 CAMERON PARK DR. MAILING ADDRESS: SAME CITY AND ZIP CODE: CAMERON PARK, CA 95682 PLAINTIFF: DEFENDANT: DECLARATION OF JUDGMENT DEBTOR REGARDING SATISFACTION OF JUDGMENT (C.C.P. 116.850) 1. 2. 3. I am the judgment Debtor in this case. Judgment was entered against me on I have Satisfied (paid) the Judgment as follows: Fully, including interest and costs. OR Partially in the amount of $ . AND The judgment creditor refuses to accept any more payments. . CASE NUMBER: 4. I have requested that the judgment creditor file an acknowledgment of satisfaction of judgment. I made my request verbally in writing on (date) . Fourteen days have passed since my request, and as of the date of this declaration, the judgment creditor has failed to or refused to comply with my request. The following documents(s), which constitutes evidence of full partial payment of the judgment is attached: Cancelled Check Money order written by me after judgment payable to and endorsed by the judgment creditor Cash receipt for the amount paid, signed by the judgment creditor. 5. I declare under penalty of perjury, under the laws of the state of California, that the foregoing is true and correct. Date Print Judgment Debtor's Name Signature of Judgment Debtor CLERK'S NOTATION OF ENTRY OF SATISFACTION Satisfaction of judgment entered in register of actions pursuant to C.C. P. 116.850(c) as follows: Full Satisfaction Partial Satisfaction in the amount of $ . Date: Clerk of the Court, by: ____________________________, Deputy Declaration Regarding Satisfaction of Judgment Local Form C-41 El Dorado County Superior Court 08/05/2011 (New) CCP 116.850 American LegalNet, Inc. www.FormsWorkFlow.com