Madera Superior Court Form Adopted for Optional Use SC - 01 Judgment Debtor222s Declaration Re: Request to Enter Satisfaction of Judgment Page 1 of 1 Revised 6/04/2018 ATTORNEY OR PARTY WITHOUT ATTORNEY (Name, state bar number, and address) TELEPHONE NO.: FAX NO.: ATTORNEY FOR (Name): FOR COURT USE ONLY SUPEROR COURT OF CALIFORNIA , COUNTY OF MADERA Madera 226 200 South G Street, Madera, California 93637 Sierra - 40601 Road 274, Bass Lake, CA 93604 PLAINTIFF: DEFENDANT: JUDGMENT DEBTOR222S 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) in the amount of $ including costs. I declare under penalty of perjury that the following is true and correct. 1. On (date) I paid to the judgment creditor (specify amount) $ the full amount of the judgment and costs as entered. 2. On (date) I asked the judgment creditor to file the Acknowledgment of Satisfaction of Judgment with 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 (city) , (state) . 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 American LegalNet, Inc. www.FormsWorkFlow.com