S DSC CIV - 243 (Rev. 5/17 ) DECLARATION OF DEFAULT RE: STIPULATED AGREEMENT Mandatory Form AND JUDGMENT THEREON ATTORNEY OR PARTY WITHOUT ATTORNEY (Name, State Bar number, and address): TE LEPHONE NO.: FAX NO.(Optional): EMAIL ADDRESS (Optional): ATTORNEY FOR (Name): FOR COURT USE ONLY SUPERIOR COURT OF CALIFORNIA, COUNTY OF SAN DIEGO CENTRA L DIVISION, SMALL C LAIMS, 330 W. BROADWAY , SAN DIEGO, CA 92101 CENTRAL DIVISION, CIVIL, 330 W. BROADWAY, ROOM 225, SAN DIEGO, CA 92101 NORTH COUNTY DIVISION, 325 S. MELROSE DR., VISTA, CA 92081 PLAINTIFF (S) DEFEND ANT (S) DECLARATION OF DEFAULT RE: STIPULATED AGREEMENT AND JUDGMENT THEREON CASE NUMBER The undersigned states that on , a Stipulated Agreement was entered into by . The Stipulated Agreement was as follows: 1. Plaintiff Defendant has failed to comply with the terms of the Stipulated Agreement signed by both parties. 2 . Plaintiff Defendant hereby requests that the dismissal be set aside and judgment be entered in fav or of the Plaintiff Defendant as follows: $ Stipulated amount (not including court costs) $ Costs of filing and service * $ Attorney fees $ Interest $ ( ) Less payments received $ Total 3 . P ossession of the premises located at . I declare under penalty of perjury under the laws of the State of California that the foregoing is true and correct. Date: Signature of Declarant NOTE: If this is a Small Claims case, you must attach the origi nal contract, check, or documents to support your claim. FOR COURT USE ONLY * REIMBURS E MENT FOR WAIVED COSTS Plaintiff(s) Defendant(s) to pay costs of $ to the San Diego Superior Court to pay costs of $ to the San Diego County Sheriff . Pursuant to Gov. Code 247 68637(b)(1), the court may refuse to enter satisfaction of judgment until the order requiring payment of waived fees and costs has been satisfie d. IT IS SO ORDERED . Date: Judge/Commissioner of the Superior Cour t American LegalNet, Inc. www.FormsWorkFlow.com