DECLARATION FOR ISSUANCE OF A WRIT OF EXECUTION Page 1 of 2 SDSC D-65(Rev. 5-03) (Family Law) ATTORNEY OR PARTY WITHOUT ATTORNEY(Name, state bar number, and address): TELEPHONE NO. (Optional): FAX NO. (Optional): E-MAIL ADDRESS (Optional): ATTORNEY FOR (Name) : FOR COURT USE ONLY SUPERIOR COURT OF CALIFORNIA, COUNTY OF SAN DIEGO CENTRAL COURTHOUSE, 1100 UNION ST., SAN DIEGO, CA 92101 COUNTY COURTHOUSE, 220 W. BROADWAY, SAN DIEGO, CA 92101 FAMILY COURT, 1555 6TH AVE., SAN DIEGO, CA, 92101 MADGE BRADLEY BLDG., 1409 4TH AVE., SAN DIEGO, CA 92101 NORTH COUNTY DIVISION, 325 S. MELROSE DR., VISTA, CA, 92081 EAST COUNTY DIVISION, 250 E. MAIN ST., EL CAJON, CA, 92020 SOUTH COUNTY DIVISION, 500 3RD AVE., CHULA VISTA, CA 91910 PLAINTIFF(S)/PETITIO NER(S) Judge: Dept: DEFENDANT(S)/RESPONDENT(S) DECLARATION FOR ISSUANCE OF A WRIT OF EXECUTIONCASE NUMBER I, , say: That declarant is in the above-entitled case; that the following judgment order was made and entered (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 PAYMENTS BALANCE DUE DATE DUE AMOUNT INTEREST DATE PAID American LegalNet, Inc. www.FormsWorkFlow.com DECLARATION FOR ISSUANCE OF WRIT OF EXECUTION Page 2 of 2 SDSC D-65(Rev. 5-03) (Family Law) CASE NUMBER: That there is actually due on said order the sum of $ principal, $ costs, $ attorney fees and $ interest, for which sum declarant requests that a Writ of Execution issue in favor of to (County) If the arrearages do not relate to child support, no other writ in the same county is outstanding and the arrearages have accrued within the past ten years. I declare under penalty of perjury under the laws of the State of California that the foregoing is true and correct. Dated: Signature American LegalNet, Inc. www.FormsWorkFlow.com