ATTORNEY OR PARTY WITHOUT ATTORNEY: STATE BAR NO.: FOR COURT USE ONLY NAME: FIRM NAME: STREET ADDRESS: CITY: STATE: ZIP CODE: TELEPHONE NO.: FAX NO.: E - MAIL ADDRESS: ATTORNEY FOR (name): SUPERIOR COURT OF CALIFORNIA, COUNTY OF ORANGE JUSTICE CENTER: Central - 700 Civic Center Dr. West, Santa Ana, CA 92701-4045 Harbor-Newport Beach Facility - 4601 Jamboree Rd., Newport Beach, CA 92660-2595 North - 1275 N. Berkeley Ave., P. O. Box 5000, Fullerton, CA 92838-0500 West 226 8141 13th Street, Westminster, CA 92683-4593 PLAINTIFF: DEFENDANT: SMALL CLAIMS - DECLARATION OF DEFAULT JUDGMENT CASE NUMBER: On (date): the above mentioned parties filed a Stipulation for Entry of Judgment. Defendant agreed to pay installments of $ per commencing . Defendant has defaulted in payments. To date, $ has been received and the installment due on (date): has not been paid. Defendant did not comply with the terms of our agreement (specify): Therefore, plaintiff requests that judgment be entered in the amount of: $ Principal, $ Interest, and $ Costs, for a TOTAL SUM OF $ . 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) (SIGNATURE OF DECLARANT) JUDGMENT IS ENTERED AS FOLLOWS: Judgment is for plaintiff and against defendant in the amount of: $ Principal, $ Interest, and $ Costs, for a TOTAL SUM OF $ Date: JUDICIAL OFFICER Judgment entered on (date): DAVID H. YAMASAKI, Clerk of the Court By: Deputy Clerk Approved for Optional Use L-1152 (Rev. March 2019)SMALL CLAIMS - DECLARATION OF DEFAULT AND JUDGMENT For your protection and privacy, please press the Clear This Form button after you are done printing the form. American LegalNet, Inc. www.FormsWorkFlow.com