Merced — MSC-CV-050

Source: https://www.merced.courts.ca.gov/system/files/forms-and-filings/msc-cv-050-declaration-judgment-debtor-regarding-satisfaction-judgment-ada-comp.pdf

MSC-CV-050 ATTORNEY OR PARTY WITHOUT ATTORNEY (Name and address) FOR COURT USE ONLY

Attorney for (Name): MERCED COUNTY SUPERIOR COURT STREET ADDRESS: 627 W. 21st Street 1159 “G” Street CITY, STATE, ZIP: Merced, CA 95340 Los Banos, CA 93635

BRANCH NAME: CIVIL PLAINTIFF/PETITIONER: CASE NUMBER: DEFENDANT/RESPONDENT:

DECLARATION OF JUDGMENT DEBTOR REGARDING SATISFACTION
OF JUDGMENT (C.C.P. §116.850)

1. My name is ____________________________________. I am the Judgment Debtor in this case.
2. Judgment was entered against me on ____________.
3. I have Satisfied (paid) the Judgment as follows:
Fully, including interest and costs.
Partially in the amount of $.
4. The Judgment Creditor refuses to accept any more payments.
5. I have requested that the Judgment Creditor file an acknowledgment of satisfaction of judgment. I
made my request verbally in writing on (date) __________________. Fourteen days have passed
since my request and, as of the date of this declaration, the Judgment Creditor has failed to or refused
to comply with my request.
6. The following document(s), which constitutes evidence of full partial payment of the judgment
is attached:
Cancelled Check
Money order written by me after judgment, payable to and endorsed by the Judgment Creditor
Cash receipt for the amount paid, signed by the Judgment Creditor

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

SIGN

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Date Print Judgment Debtor’s Name Signature of Judgment Debtor

CLERK’S CERTIFICATE OF ENTRY OF SATISFACTION

Satisfaction of judgment entered in register of actions, pursuant to C.C.P. §116.850(c) as follows: Full Satisfaction Partial Satisfaction in the amount of $______________.

Date: _____________ Clerk of the Court,
(Court Seal)
by: ___________________________, Deputy

For Optional Use DECLARATION OF JUDGMENT DEBTOR REGARDING Page 1 of 1 MSC-CV-050 [Eff. Jan. 1, 2022] SATISFACTION OF JUDGMENT (C.C.P. §116.850)