Attorney or Party without attorney (Name and Address) Telephone No.: Attorney for: NAME OF COURT: SUPERIOR COURT OF CALIFORNIA, COUNTY OF SHASTA Mailing Address Street Address 1500 Court Street, Room 319 Redding, CA 96001 Branch Name: Redding PLAINTIFF/PETITIONER: DEFENDANT/RESPONDENT: DECLARATION AND ORDER RE: SATISFACTION OF JUDGMENT Case Number: Small Claims I, __________________________________declare as follows: I am the debtor in the above-entitled action; that the judgment entered against me in this case on _____________________ in the amount of $____________ was paid to creditor(s) ___________________________on __________________, as evidenced by the attached documents; that the creditor(s) did not file with the Court a Satisfaction Of Judgment and that the creditor(s) cannot be located to obtain such Satisfaction Of Judgment. I hereby request that the Court enter a Satisfaction of Judgment in this matter, based on this Declaration and the attached documents. A copy of this request was mailed first-class, postage prepaid, in a sealed envelope addressed to the creditor(s) at his/her last known address of: __________________________________________ _____________________________________________________________________________________________ I declare under penalty of perjury under the laws of the State of California that the foregoing is true and correct. Executed at _____________________, California, on (date)________________________________ _____________________________________________ Signature of Declarant _____________________________________________________________________________________________ ORDER IT IS HEREBY ORDERED that the judgment entered in the above entitled matter on _______________, in favor of plaintiff and against defendant, is hereby declared satisfied; and this Order shall be considered for all intents and purposes as a SATISFACTION OF JUDGMENT, pursuant to the provisions of Section 116.850 of the California Code of Civil Procedure. __________________________ Dated _______________________________________________ Judge/Commissioner of the Superior Court _____________________________________________________________________________________ Form Approved for Optional Use Shasta County Superior Court LF-012 [rev May 28, 2010] DECLARATION AND ORDER RE SATISFACTION OF JUDGMENT (Small Claims) Code of Civil Procedure § 116.850 Page 1 of 1 American LegalNet, Inc. www.FormsWorkFlow.com