NAME, ADDRESS, AND TELEPHONE NUMBER OF PARTY Reserved for Court Use SUPERIOR COURT OF CALIFORNIA, COUNTY OF NAPA 825 Brown Street Napa CA 94559 Plaintiff: Defendant: DECLARATION OF JUDGMENT DEBTOR FOR ENTRY OF SATISFACTION OF JUDGMENT [SMALL CLAIMS] CASE NUMBER: 1. I am the judgment debtor in this case. 2. Judgment was entered against me on ________________. 3. I have satisfied (paid) the judgment as follows: Fully, including accrued interest, costs and administrative fees, if applicable. Partially, in the amount of $_________________. The judgment creditor refuses to accept any more payments. 4. I have requested that the judgment creditor file an acknowledgment of satisfaction of judgment. I made my request in writing on (date) _________________. As of the date of this application, the judgment creditor has failed or refused to comply with my request. I have been unable to contact the judgment creditor because his/her address is unknown. 5. I have served by mail a copy of this Application for Entry of Satisfaction of Judgment [Small Claims] at the judgment creditor’s last known address as follows: 6. The following documents, which constitute evidence of attached: full partial payment of the judgment are Cancelled check money order written by me after judgment and made payable to, and endorsed by, the judgment creditor. Cash receipt for the amount paid, signed by the judgment creditor. Other:__________________________________________________. I declare under penalty of perjury, under the laws of the State of California, that the foregoing is true and correct. Date Type or Print Judgment Debtor’s Name Signature of Judgment Debtor CLERK’S ENTRY OF SATISFACTION OF JUDGMENT Satisfaction of judgment is entered pursuant to Code of Civil Procedure §116.850 (c) as follows: Full satisfaction. Partial satisfaction in the amount of $______________. Richard D. Feldstein, Court Executive Officer Date: By: ,Deputy January 2010 American LegalNet, Inc. www.FormsWorkFlow.com