Attorney or Party Without An Attorney (Name, State Bar No. & Address) For Court Use Only Telephone No. Attorney for: Superior Court of California, County of San Bernardino Petitioner: Respondent: DECLARATION AND ORDER FOR ISSUANCE OF WRIT OF EXECUTION/ABSTRACT OF JUDGMENT -BLACK INK ONLY ­ I, That declarant is , say: CASE NUMBER in the above entitled action; that the following (judgment) (order) was made, and entered: SB-12 Rev.05/2013 American LegalNet, Inc. www.FormsWorkFlow.com (Where payments accrue at different times, fill in data below; in other cases, strike out inapplicable portions.) Failure to claim interest shall be deemed a waiver thereof. That the payments accrued and interest thereon, and the payments made and interest thereon, are as follows: ACCRUALS DATE DUE AMOUNT INTEREST DATE PAID PAYMENTS AMOUNT INTEREST BALANCE DUE That there is actually due on said order the sum of $ principal, $ costs, $ Attorney fees and $ interest, for which sum affiant prays that a Writ of Execution / Abstract of Judgment issue in favor of to _____________________________________________. County I declare under penalty of perjury that the foregoing is true and correct. Executed on at , California. ________________________________________________ Signature ORDER FOR ISSUANCE OF WRIT OF EXECUTION/ABSTRACT OF JUDGMENT Upon reading the declaration of and good cause Appearing therefore, it is ordered that a Writ of Execution/Abstract of Judgment issue is the sum of $ , principal; $ , costs; $ , attorney fees; and $ , interest; in favor of to ______________________________________ County Dated ___________________________________ ____________________________________ Judge/Commissioner SB-12 Rev.05/2013 American LegalNet, Inc. www.FormsWorkFlow.com