ATTORNEY OR PARTY WITHOUT ATTORNEY (Name, Address, Telephone Number, and State Bar membership number): COURT USE ONLY SUPERIOR COURT OF CALIFORNIA, COUNTY OF SONOMA 600 Administration Drive, Rm. 107-J Santa Rosa, CA 95403 Telephone: (707) 565-1100 PLAINTIFF: DEFENDANT: Case Number: DECLARATION AND ORDER FOR PRESUMED SATISFACTION OF JUDGMENT AND NOTICE OF ENTRY OF ORDER I declare that I am the Judgment Debtor in the above-entitled action. Judgment was entered against me on . I have paid the judgment in full including accrued interest and costs. The judgment creditor has been requested to file an acknowledgment of satisfaction of the judgment and refuses to do so, or the present address of the judgment creditor is unknown. The following documents which accompany this declaration constitute evidence of the judgment creditor's receipt of full payment of this judgment (List documents): _______________________________________________________________________________________ _______________________________________________________________________________________. I declare under penalty of perjury that the foregoing is true and correct. Date: _______________________ _________________________________________ ____ Signature of Declarant _____________________________________________ Name (print) COURT ORDER AND NOTICE OF ENTRY OF ORDER Judgment debtor having created a rebuttable presumption of Satisfaction of Judgment pursuant to Section 116.850(c) of the Code of Civil Procedure, the Clerk of the Court is hereby ordered to enter a Satisfaction of Judgment. Dated_______________________ ______________________________________________ Judge of the Superior Court CCP 116.850(c) SC-5, Rev. 7/1/2011 DECLARATION AND ORDER FOR PRESUMED SATISFACTION OF JUDGMENT AND NOTICE OF ENTRY OF ORDER Form Approved for Optional Use American LegalNet, Inc. www.FormsWorkFlow.com