File No. STATE OF NORTH CAROLINA Film No. County Judgment Docket Book & Page No.Abstract No.Name Of Plaintiff VERSUS CERTIFICATE OF PAYMENT Name Of Defendant ON JUDGMENT PAYMENT IN FULL PARTIAL PAYMENT County To Which Certificate Is Forwarded G.S. 1-239(a) TO THE CLERK OF SUPERIOR COURT OF THE COUNTY TO WHICH THIS CERTIFICATE IS FORWARDED: I certify that: 1. the judgment in the above action has been PAID AND SATISFIED IN FULL and this has been noted on the judgment docket of this county. 2. a partial payment on the judgment in the above action in the amount set forth below has been made and noted on the judgment docket of this county. Amount Of Partial Payment $ Your Judgment Docket Book & Page No. Date Signature Deputy CSC Assistant CSC Clerk Of Superior Court NOTE TO CLERK OF SUPERIOR COURT: For partial payments, the law requires that this Certificate be sent only if you are requested to do so by a clerk to whom a transcript of judgment has been sent or by a party making the partial payment. AOC-CV-404, Rev. 9/03 2003 Administrative Office of the Courts