San Luis Obispo — SC002

Source: https://www.slo.courts.ca.gov/documents/san-luis-obispo/sc002.pdf

PARTY NAME AND ADDRESS

Plaintiff/Defendant

SUPERIOR COURT OF SAN LUIS OBISPO COUNTY SMALL CLAIMS DIVISION L San Luis Obispo Branch, 1035 Palm Street, Rm 385, San Luis Obispo, CA 93408 L Grover Beach Branch, 214 South 16th Street, Grover Beach, CA 93433 L Paso Robles Branch, 901 Park Street, Paso Robles, CA 93446

Plaintiff:

Defendent:

DECLARATION OF DEFAULT IN PAYMENTS CASE NO:
(SMALL CLAIMS)

I, declare as follows:

DECLARANT NAME

I am the plaintiff/defendant in the within action. A judgment was entered into on ,

For $ against ;

JUDGMENT DEBTOR NAME

the court ordered the judgment to be paid in installments of $ per month, commencing , and said plaintiff/defendant has defaulted in making payments.

To date I have received $ on my claim.

The installment due on has not been paid.

Therefore, I request that execution issue.

On , I mailed (by regular U.S. mail) a copy of this Declaration and Request that Execution Issue to plaintiff/defendant, at:

STREET ADDRESS

CITY STATE ZIP

I declare under penalty of perjury under the laws of the State of California the foregoing is true and correct.

DATE SIGNATURE OF DECLARANT

SC002 DECLARATION OF DEFAULT IN PAYMENTS CCP 116.620 Rev. 08/01/2009 Optional (SMALL CLAIMS)