ATTORNEY OR PARTY WITHOUT ATTORNEY (Name & Address): FOR COURT USE ONLY Telephone No.: E-Mail Address (Optional): ATTORNEY FOR (Name): Fax No. (Optional): Bar No: SUPERIOR COURT OF CALIFORNIA, COUNTY OF ORANGE JUSTICE CENTER: Central - 700 Civic Center Dr. West, Santa Ana, CA 92701-4045 Civil Complex Center - 751 W. Santa Ana Blvd., Santa Ana, CA 92701-4512 Harbor-Newport Beach Facility - 4601 Jamboree Rd., Newport Beach, CA 92660-2595 Lamoreaux - 341 The City Drive, Orange, CA 92868-3205 North - 1275 N. Berkeley Ave., P. O. Box 5000, Fullerton, CA 92838-0500 th West - 8141 13 Street, Westminster, CA 92683-4593 PLAINTIFF: DEFENDANT: CASE NUMBER: Unlimited civil actions only. Case assigned to: Judge: Department: Date complaint filed: Hearing/trial date: DECLARATION RE: DEFAULT IN PAYMENTS/PARTIAL SATISFACTION The undersigned Judgment creditor Attorney for judgment creditor in the above-entitled action declares: Judgment was entered against the following named defendant(s): on for $ . The Court ordered the judgment paid in installments of $ per commencing . To date, $ has been received in partial satisfaction of the judgment and the installment due on has not been paid. Therefore, judgment creditor requests that a writ of execution issue. Complete if Partial Satisfaction: Full name and address of judgment creditor or assignee of record: Full name and address of judgment debtor being partially released: Judgment entered or renewal entered on (date): An Abstract of Judgment has been recorded as follows (complete all information for each county where recorded): COUNTY DATE OF RECORDING BOOK NUMBER PAGE NUMBER A Notice of Judgment Lien has been filed in the office of the Secretary of State as file number (specify): 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 NAME) Approved for Optional Use L1061 (Rev. July 1, 2013) (SIGNATURE OF JUDGMENT CREDITOR OR ATTORNEY) DECLARATION RE: DEFAULT IN PAYMENTS/PARTIAL SATISFACTION Code of Civil Procedure, § 724.120 American LegalNet, Inc. www.FormsWorkFlow.com