FOR COURT USE ONLY ATTORNEY OR PARTY WITHOUT ATTORNEY (Name, state bar number, and address) TELEPHONE NO.: FAX NO.: ATTORNEY FOR (Name): SUPEROR COURT OF CALIFORNIA, COUNTY OF MADERA ▫ ▫ Madera - 209 West Yosemite Avenue, Madera, California 93637 Sierra - 40601 Road 274, Bass Lake, CA 93604 PLAINTIFF: DEFENDANT: JUDGMENT DEBTOR’S DECLARATION RE: REQUEST TO ENTER SATISFACTION OF JUDGMENT PURSUANT TO CCP 116.850 AND ORDER CASE NUMBER: DECLARATION AND REQUEST I am the Judgment debtor in the above-entitled action, in which judgment was entered on (date) the amount of $ in including costs. I declare under penalty of perjury that the following is true and correct. I paid to the judgment creditor (specify amount) $ 1. On (date) the full amount of the judgment and costs as entered. I asked the judgment creditor to file the Acknowledgment of Satisfaction of Judgment with 2. On (date) the court and (check a box) ▫ The judgment creditor refuses to file an Acknowledgment of Satisfaction of Judgment with the court. ▫ The present address of the judgment creditor is unknown. 3. I have attached the following (specify receipt, cancelled check or money order and number) as evidence of receipt of payment: 4. I respectfully request that the court enter the Acknowledgment of Satisfaction of Judgment in the above-entitled action. This declaration is executed under penalty of perjury under the laws of the State of California on (date) _________________________ at , (state) _________________________________ . (city) Dated: __________________________ Signature of Judgment Debtor ORDER IT IS SO ORDERED for the clerk of the court to enter the Acknowledgment of Satisfaction of Judgment. Dated: __________________________ Judge of the Superior Court MCSC SC-01 (NEW 11-25-07) American LegalNet, Inc. www.FormsWorkFlow.com