Superior Court of California COUNTY OF SANTA CRUZ  701 Ocean Street, Room 110 Santa Cruz, CA 95060 (831) 454-2200  1 Second Street, Room 300 Watsonville, CA 95076 (831) 786-7200 Plaintiff: Case No. ____________________________ vs. DECLARATION RE: DEFAULT IN PAYMENTS Defendant: I, the undersigned Judgment Creditor in the above entitled action declares: That judgment was entered against Judgment Debtor ___________________________________ on for $ installments of $ ; that the Court ordered the judgment be paid in per month, commencing That the installment due on . has not been paid. I certify (or declare), under penalty of perjury that the foregoing is true and correct. Executed on at , California. ____________________________________ Judgment Creditor cc: _________________________ _________________________ _________________________ _________________________ supsc.020 (Rev 6/11/08) American LegalNet, Inc. www.FormsWorkflow.com