NAME, ADDRESS, AND TELEPHONE NUMBER OF ATTORNEY OR PARTY WITHOUT ATTORNEY: STATE BAR NUMBER Reserved for Clerk's File Stamp ATTORNEY FOR (Name): SUPERIOR COURT OF CALIFORNIA, COUNTY OF LOS ANGELES COURTHOUSE ADDRESS: PLAINTIFF/PETITIONER: DEFENDANT/RESPONDENT: REQUEST FOR ENTRY OF JUDGMENT, JUDGMENT, AND NOTICE OF ENTRY OF JUDGMENT WELFARE AND INSTITUTIONS CODE SECTION 903 AND ISSUANCE OF A WRIT OF EXECUTION AND/OR OTHER ENFORCEMENT CASE NUMBER: REQUEST FOR ENTRY OF JUDGMENT PURSUANT TO WELFARE AND INSTITUTIONS CODE SECTION 903. 1. 2. The Probation Department has complied with the provisions of Article 25, Section 900 et seq. of the Welfare and Institutions Code. The Clerk of the Court is requested to enter judgment in favor of the Probation Department, County of Los Angeles, against the defendant(s) pursuant to the Welfare and Institutions Code section 903 as follows: a. Principal ...................................................................................................$ _________________________ b. Costs (including civil filing fee and administrative charge).......................$ _________________________ c. Total amount of judgment requested.....................................................$ _________________________ d. Plus interest after judgment at the legal rate. I declare under penalty of perjury under the laws of the State of California that the foregoing is true and correct. Dated: Director, Probation Department By: LACIV 184 (Rev. 09/13) LASC Approved 07-05 REQUEST FOR ENTRY OF JUDGMENT, JUDGMENT, AND NOTICE OF ENTRY OF JUDGMENT WELFARE AND INSTITUTIONS CODE SECTION 903 Welf. & Inst. Code, § 903; Gov. Code, § 6103.5(d) Page 1 of 2 American LegalNet, Inc. www.FormsWorkFlow.com PLAINTIFF/PETITIONER (Name): DEFENDANT/RESPONDENT (Name): CASE NUMBER JUDGMENT AND NOTICE OF ENTRY OF JUDGMENT Judgment entered in favor of the Probation Department, County of Los Angeles. a. Principal.......................................................................................................$ ___________________________ b. Costs (including civil filing fee and administrative charge)..........................$ ___________________________ c. d. Total amount of judgment.........................................................................$ ___________________________ Plus interest after judgment at the legal rate. . All fees waived by the court must be reimbursed upon partial or full SHERRI R. CARTER, Executive Officer/Clerk By: Deputy Clerk Judgment entered on recovery of judgment. Dated: CERTIFICATE OF MAILING I, the below-named Executive Officer/Clerk of the above-entitled court, do hereby certify that I am not a party to the cause herein, and that on this date I served the Request for Entry of Judgment, Judgment, and Notice of Entry of Judgment - Welfare and Institutions Code section 903 upon each party or counsel named below by depositing in the United States mail at the courthouse in , California, one copy of the original filed/entered herein in a separate sealed envelope to each address as shown below with the postage thereon fully prepaid. SHERRI R. CARTER, Executive Officer/Clerk By: Deputy Clerk LACIV 184 (Rev. 09/13) LASC Approved 07-05 REQUEST FOR ENTRY OF JUDGMENT, JUDGMENT, AND NOTICE OF ENTRY OF JUDGMENT WELFARE AND INSTITUTIONS CODE SECTION 903 Welf. & Inst. Code, § 903; Gov. Code, § 6103.5(d) Page 2 of 2 American LegalNet, Inc. www.FormsWorkFlow.com