File No. STATE OF NORTH CAROLINA Abstract No. Judgment Docket Book & Page No. County Name Of Plaintiff(s) CERTIFICATE OF PAYMENT/ SATISFACTION OF JUDGMENT BY JUDGMENT CREDITOR VERSUS Name Of Defendant(s) PAYMENT IN FULL PARTIAL PAYMENT G.S. 1-239(c) TO THE CLERK OF SUPERIOR COURT: I certify that: 1. I am or represent the 2. plaintiff/judgment creditor defendant/judgment creditor in the above action. a. the judgment in the above action has been PAID AND SATISFIED IN FULL and I authorize you to note this satisfaction in your judgment records. Amount Of Partial Payment b. a partial payment on the judgment in the above action in the amount set forth to the side has been made on the date indicated and I authorize you to note this partial payment in your records. $ Date Of Partial Payment ATTORNEY FOR JUDGMENT CREDITOR Date Signature Of Attorney For Judgment Creditor Attorney Bar No. Name Of Attorney For Judgment Creditor (Type Or Print) INDIVIDUAL JUDGMENT CREDITOR PARTNERSHIP JUDGMENT CREDITOR Date Date Name Of Partnership (Type Or Print) Signature Of Individual Judgment Creditor Signature Of Partner Authorized To Cancel Judgment Name Of Individual Judgment Creditor (Type Or Print) Name Of Partner Signing (Type Or Print) CORPORATE JUDGMENT CREDITOR Date Name Of Corporate Judgment Creditor (Type Or Print) Signature Of Secretary Of Corporation Signature Of Person Signing Name Of Person Signing (Type Or Print) ATTEST: Title Of Person Authorized To Cancel Judgment CORPORATE SEAL Secretary Assistant Secretary MULTIPLE JUDGMENT CREDITORS OR PARTNERSHIPS NOTE: All judgment creditors must sign. Date Signature Of Multiple Judgment Creditor 1 Date Signature Of Multiple Judgment Creditor 3 Name Of Multiple Judgment Creditor 1 (Type Or Print) Name Of Multiple Judgment Creditor 3 (Type Or Print) Date Date Signature Of Multiple Judgment Creditor 2 Name Of Multiple Judgment Creditor 2 (Type Or Print) Signature Of Multiple Judgment Creditor 4 Name Of Multiple Judgment Creditor 4 (Type Or Print) VERIFICATION I, the undersigned being first duly sworn, say that I have read this Certificate and the contents are true to my own knowledge, except as to matters stated on information and belief, and as to those, I believe them to be true. Date SWORN/AFFIRMED AND SUBSCRIBED TO BEFORE ME Date Signature Of Person Authorized To Administer Oaths Deputy CSC Signature Of Person Signing Certificate Assistant CSC Clerk Of Superior Court Date My Commission Expires Notary County Where Notarized SEAL AOC-CV-413, Rev. 12/06, © 2006 Administrative Office of the Courts American LegalNet, Inc. www.FormsWorkflow.com