ATTORNEY OR PARTY WITHOUT ATTORNEY (Name, State Bar number, and address): FOR COURT USE ONLY TELEPHONE NO: E-MAIL ADDRESS (Optional): ATTORNEY FOR (Name): FAX NO. (Optional) SUPERIOR COURT OF CALIFORNIA, COUNTY OF MENDOCINO ADDRESS: CITY AND ZIP CODE: BRANCH NAME: CASE NUMBER: PETITIONER/PLAINTIFF: ___________________________________________ RESPONDENT/DEFENDANT: HEARING DATE: TIME: DEPT.: SMALL CLAIMS AGREEMENT This is not a judgment. This matter is dismissed without prejudice. All parties consent to the court retaining personal and subject matter jurisdiction over this matter pursuant to CCP §664.6, which allows for enforcement of this agreement. They further request that the court, as applicable in the event of default, vacate this dismissal and enter an order of judgment to enforce the terms of this agreement upon plaintiff's filing of a Noticed Motion Requesting Entry of Judgment and Supporting Declaration. (available at the Self Help Center). 1. Defendant(s) shall pay to plaintiff(s), the amount of . That amount is to be paid in monthly/weekly installments until paid in full. Each monthly/weekly installment is to be in the amount of on or before the of each month/week, beginning on . 2. Other terms 3. For purposes of service of process by mail in the event of default, Defendant's address of record is as follows: (no P.O. Boxes unless mail is not delivered to physical address) If Defendant(s) defaults as to any terms of this stipulated agreement, judgment shall be entered upon filing of a Noticed Motion Requesting Entry of Judgment and Supporting Declaration with the court. Judgment shall include the following: 1. Balance due in accordance with the terms of this agreement. 2. The entire amount, less any payments already made, originally asked for in the complaint. 3. Other Defendant understands that he or she has 10 days from the date of receipt of the plaintiff's regular mail notice to request a hearing contesting entry of judgment. Date: Plaintiff signature MSC-101 (new 0109) Defendant signature American LegalNet, Inc. www.FormsWorkflow.com