Los Angeles local civil form — To prevent other people from seeing what you have entered on your form, please press the Clear This Form… (LASC LACIV 184)

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NAME, ADDRESS, AND TELEPHONE NUMBER OF ATTORNEY OR PARTY WITHOUT ATTORNEY: STATE BAR NUMBER Reserved for Clerk’s File Stamp

ATTORNEY FOR (Name): SUPERIOR COURT OF CALIFORNIA, COUNTY OF LOS ANGELES COURTHOUSE ADDRESS:

PLAINTIFF/PETITIONER:

DEFENDANT/RESPONDENT:

REQUEST FOR ENTRY OF JUDGMENT, JUDGMENT, CASE NUMBER:
AND NOTICE OF ENTRY OF JUDGMENT -
WELFARE AND INSTITUTIONS CODE SECTION 903
AND ISSUANCE OF A WRIT OF EXECUTION
AND/OR OTHER ENFORCEMENT

REQUEST FOR ENTRY OF JUDGMENT PURSUANT TO WELFARE AND INSTITUTIONS CODE SECTION 903.

1. The Probation Department has complied with the provisions of Article 25, Section 900 et seq. of the Welfare and Institutions Code.

2. The Clerk of the Court is requested to enter judgment in favor of the Probation Department, County of Los Angeles, against the defendant(s) pursuant to the Welfare and Institutions Code section 903 as follows:

   a. Principal ...................................................................................................$ _________________________

   b. Costs (including civil filing fee and administrative charge).......................$ _________________________

   c. Total amount of judgment requested……………......................................$ _________________________

   d. Plus interest after judgment at the legal rate.

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

Dated: Director, Probation Department

By:

SCLAC LACIV 184 Rev. 04/26 REQUEST FOR ENTRY OF JUDGMENT, JUDGMENT, Welf. & Inst. Code, § 903; For Optional Use AND NOTICE OF ENTRY OF JUDGMENT - Gov. Code, § 6103.5(d) WELFARE AND INSTITUTIONS CODE SECTION 903 Page 1 of 2

PLAINTIFF/PETITIONER (Name): CASE NUMBER

DEFENDANT/RESPONDENT (Name):

JUDGMENT AND NOTICE OF ENTRY OF JUDGMENT

Judgment entered in favor of the Probation Department, County of Los Angeles.

a.Principal.......................................................................................................$ ___________________________

b. Costs (including civil filing fee and administrative charge).................... ......$ ___________________________

c. Total amount of judgment……………..........................................................$ ___________________________

d. Plus interest after judgment at the legal rate.

Judgment entered on . All fees waived by the court must be reimbursed upon partial or full recovery of judgment.

Dated: DAVID W. SLAYTON, Executive Officer/Clerk of Court

By: Deputy Clerk

CERTIFICATE OF MAILING

I, the below-named Executive Officer/Clerk of Court of the above-entitled court, do hereby certify that I am not a party to

the cause herein, and that on this date I served the (Begin Underline) Request for Entry of Judgment, Judgment, and Notice

(Begin Underline) Request for Entry of Judgment, Judgment,upon each party or counsel named below by depositing in the

United States mail at the courthouse in , California, one copy of the original filed/entered

herein in a separate sealed envelope to each address as shown below with the postage thereon fully prepaid.

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DAVID W. SLAYTON, Executive Officer/Clerk of Court

By: Deputy Clerk

To protect your privacy, please press the Clear This Form button after you have printed this form. SCLAC LACIV 184 Rev. 04/26 REQUEST FOR ENTRY OF JUDGMENT, JUDGMENT, Welf. & Inst. Code, § 903; For Optional Use AND NOTICE OF ENTRY OF JUDGMENT - Gov. Code, § 6103.5(d) WELFARE AND INSTITUTIONS CODE SECTION 903 Page 2 of 2

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