Name, Address & Phone number of Requesting Party FOR COURT USE ONLY SUPERIOR COURT OF CALIFORNIA COUNTY OF YOLO 1000 MAIN STREET WOODLAND,CA. 95695 530-406-6904 Plaintiff: Defendant: Case Number: CV-CLEX PARTE REQUEST FOR ENTRY OF JUDGMENT I, _____________________________________ declare that: Print Name 1. I am a party to the above entitled action. 2. That on _______________________________, the parties stipulated that Defendant would pay Plaintiff installment payments as follows: $_________________ per month/week beginning on ____________________, and on the __________ day of each month/week thereafter until paid in full at which time a dismissal would have been filed. 3. That to date, I have received: [ ] No payment [ ] A total of $________________, the last payment received on __________________. 4. That because of said missed payment(s), I request that judgment for the balance of $_______________ plus $_______________ costs, for a total of $_____________________ be entered. I declare under penalty of perjury that the foregoing is true and correct. Dated: _______________________ YOCV0138 Rev 060816 ______________________________________ Signature of Declarant American LegalNet, Inc. www.FormsWorkFlow.com