ATTORNEY OR PARTY WITHOUT ATTORNEY ( Name and Address ) TELEPHONE NO. ATTORNEY FOR ( Name ) FOR COURT USE ONLY SUPERIOR COURT OF CALIFORNIA, COUNTY OF SAN BERNARDINO STREET ADDRESS MAILING ADDRESS CITY AND ZIP CODE BRANCH NAME PLAINTIFF: DEFENDANT: DECLARATION AND ORDER RE: SATISFACTION OF JUDGMENT CASE NUMBER I, , am the Judgment Debtor in the above- named action and do hereby request that the Court order that Satisfaction of Judgment be entered pursuant to Sections 116.850(c) and 724.050(d) of the Civil Code of Procedure. I declare: 1. That the Judgment Creditor in this action has been paid, in full, the amount of said judgment and costs. 2. That Judgment Creditor has been requested to file a Satisfaction of Judgment and refused to do so or the present address of judgment creditor is unknown. 3. The documents attached to this statement constitute evidence of receipt of payment by creditor. I DECLARE UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF CALIFORNIA THAT THE FOREGOING IS TRUE AND CORRECT Date Declarant Date Judge/Commissioner/Judge Pro Tem DECLARATION AND ORDER RE: SATISFACTION OF JUDGMENT 13-19674-360 Rev. 04-2014 Optional American LegalNet, Inc. www.FormsWorkFlow.com