ATTORNEY OR PARTY WITHOUT ATTORNEY (Name, State Bar number, and address): FOR COURT USE ONLY TELEPHONE NO.: EMAIL ADDRESS (Optional): ATTORNEY FOR (Name): FAX NO.(Optional): SUPERIOR COURT OF CALIFORNIA, COUNTY OF SAN DIEGO CENTRAL DIVISION, SMALL CLAIMS, 330 W. BROADWAY, ROOM 241, 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) DEFENDANT(S) DECLARATION RE: DEFAULT IN INSTALLMENT PAYMENTS AND ORDER THEREON The undersigned judgment creditor in the above-entitled action declares: CASE NUMBER Judgment was entered against judgment debtor ___________________________________________________________ on ________________________ for $____________________________; the court ordered the judgment paid in installments of $__________________________ per month commencing on _________________ and on the ________________ day of each month thereafter until paid in full. $_________________ has been paid on the judgment. Debtor has failed to comply with the terms of the judgment by failing to make the payment due and payable on or before ____________________. Therefore, judgment creditor requests that writ of execution be issued for the balance due. I declare under penalty of perjury under the laws of the State of California that the foregoing is true and correct. Date: Signature of Judgment Creditor IT IS SO ORDERED. Date: Judge/Commissioner of the Superior Court SDSC CIV-242 (Rev. 12/14) Optional Form DECLARATION RE: DEFAULT IN INSTALLMENT PAYMENTS AND ORDER THEREON American LegalNet, Inc. www.FormsWorkFlow.com