SUPERIOR COURT OF CALIFORNIA, COUNTY OF PLACER Form Adopted for Mandatory Use www.placer.courts.ca.gov Superior Court of California, County of Placer Page 1 of 2 Form No. PL-CV010 Effective 10-26-2018 ATTORNEY OR PARTY WITHOUT ATTORNEY (Name, State Bar Number, and Address): TELEPHONE NO.: FAX NO.: EMAIL ADDRESS: FOR COURT USE ONLY SUPERIOR COURT OF CALIFORNIA, COUNTY OF PLACER 10820 Justice Center Drive 2501 N. Lake Blvd. P.O. Box 619072 P.O. Box 5669 Roseville, CA 95661-9072 Tahoe City, CA 96145 PETITIONER/PLAINTIFF: RESPONDENT /DEFENDANT: C ERTIFICATE OF SATISFACTION OF JUDGMENT BY CLERK Case Number: Judgment was entered in this matter on ; no renewals of judgment have been filed. The defendant(s)/judgment debtor(s) having complied with the requirements of California Code of Civil Procedure 247 116.850, establishing that the judgment in the above-entitled case has been satisfied, a satisfaction of that judgment is hereby entered. seal Dated: Jake Chatters, Clerk of the Placer County Superior Court By: , Deputy Clerk American LegalNet, Inc. www.FormsWorkFlow.com SUPERIOR COURT OF CALIFORNIA, COUNTY OF PLACER Form Adopted for Mandatory Use www.placer.courts.ca.gov Superior Court of California, County of Placer Page 2 of 2 Form No. PL-CV010 Effective 10-26-2018 ATTORNEY OR PARTY WITHOUT ATTORNEY (Name, State Bar Number, and Address): TELEPHONE NO.: FAX NO.: EMAIL ADDRESS: FOR COURT USE ONLY SUPERIOR COURT OF CALIFORNIA, COUNTY OF PLACER 10820 Justice Center Drive 2501 N. Lake Blvd. P.O. Box 619072 P.O. Box 5669 Roseville, CA 95661 - 9072 Tahoe City, CA 96145 PETITIONER/PLAINTIFF: RESPONDENT /DEFENDANT: Declaration of Judgment Debtor in support of application to have Satisfaction of Judgment entered by clerk (CCP 247 116.850) Case Number: The undersigned declares as follows: 1. I am a judgment debtor in the above-entitled case. 2. I have made full payment of the judgment, including accrued interest and costs. 3. The judgment creditor has been requested to file an acknowledgment of satisfaction of the judgment and refuses to do so. 4. I have attached to this declaration evidence of payment of the judgment in the form of copies of a canceled check(s) or money order(s) written by me after the judgment made payable to, and endorsed by, the judgment creditor. -OR- 5. I have attached to this declaration evidence of payment of the judgment in the form of a receipt for the full payment of the judgment written by me and signed by the judgment creditor. I declare under penalty of perjury under the laws of the State of California that the foregoing is true and correct and that this declaration was executed by me on in , California. Declarant, Judgment Debtor American LegalNet, Inc. www.FormsWorkFlow.com