CASB — Adversary No. (CSD3057A_2024-12-01_final_R1)

Source: https://www.casb.uscourts.gov/sites/casb/files/documents/forms/CSD3057A_2024-12-01_final_R1.pdf

CSD 3057A [12/01/24]

Name, Address, Telephone No. & ID No.

UNITED STATES BANKRUPTCY COURT SOUTHERN DISTRICT OF CALIFORNIA 325 West F Street, San Diego, California 92101-6991

In Re Bankruptcy No.

Debtor(s)

Adversary No.

Plaintiff(s)

v.

Defendant(s)

DECLARATION IN SUPPORT OF REQUEST FOR ISSUANCE OF WRIT OF EXECUTION

I, ___________________________________, declare as follows:

1. I claim the following costs after judgment incurred within the last two years:

$ ___________________ incurred on the _____ day of _______________, 20.
Description
$ ___________________ incurred on the _____ day of _______________, 20.
Description
$ ___________________ incurred on the _____ day of _______________, 20.
Description

Resulting in $ ____________________ total costs added.

[Attach any additional Memorandum of Costs or Motions to Claim Costs (“MOC”)]

$ ___________________ total costs have been added since judgment was entered.

2. CREDIT must be given for the following payments and partial satisfactions (“PS”):

$ ___________________ incurred on the _____ day of _______________, 20.
$ ___________________ incurred on the _____ day of _______________, 20.
$ ___________________ incurred on the _____ day of _______________, 20.

[Attach any additional payments or partial satisfactions]

[Credits are first applied toward outstanding costs/interest then to remaining principal]

CSD 3057A [12/01/24]

3. INTEREST has accrued in the following amounts in accordance with the costs added and partial
satisfactions made toward the judgment:

Interest accrues at ____ % per annum.

$ ___________________ from [date of judgment] to [date of first MOC or PS]
$ ___________________ from [date of first MOC or PS] to [date of next MOC or PS]

[Attach any additional interest calculations; interest ceases to accrue on any portion of paid principal as of
the time that payment is made]

$ ___________________ Total Interest Accrued

Leaving $ ______________________ PRESENTLY DUE on this date. OF THIS TOTAL, $ _______________ is
the amount of the original judgment as entered still remaining due and bearing interest at ____ % in the amount of
$ ___________ per day from this date.

I hereby declare under penalty of perjury that the foregoing statements are true and correct to the best of my knowledge and belief.

DATED: ___________________________________________
Signature of Judgment Creditor

By: ___________________________________________

Its: ___________________________________________

Name of Judgment Creditor: ___________________________________________