PLAINTIFF/PETITIONER: DEFENDANT/RESPONDENT: Attachment to: Request to Pay Judgment to Court (JC Form #SC-145) Notice of Entry of Judgment (JC Form #SC-130) CASE NUMBER Acknowledgment of Satisfaction of Judgment (JC Form #EJ-100) Other: DECLARATION CONCERNING WAIVED COURT FEES A party petitioning the court to enter satisfaction of judgment shall declare, under penalty of perjury, that any order requiring payment of waived fees and costs has been satisfied. The court may refuse to enter full or partial satisfaction of judgment until order to repay waived fees and costs is paid. 1. The court waived fees and costs in this action for (name): 2. All court fees and costs that were waived in this action have been paid to the court (check one): Yes No I declare under penalty of perjury under the laws of the State of California that the information above is true and correct. Date: (TYPE OR PRINT NAME OF ATTORNEY PARTY MAKING DECLARATION) (SIGNATURE) SDSC CIV-365 (New 7/09) DECLARATION CONCERNING WAIVED COURT FEES American LegalNet, Inc. www.FormsWorkFlow.com