Placer — Satisfaction of Judgment by Clerk and Declaration

Source: https://www.placer.courts.ca.gov/sites/default/files/pl-cv010.pdf

SUPERIOR COURT OF CALIFORNIA, COUNTY OF PLACER

ATTORNEY OR PARTY WITHOUT ATTORNEY FOR COURT USE ONLY
(Name, State Bar Number, and Address):

TELEPHONE NO.:
FAX NO.:
EMAIL ADDRESS:
SUPERIOR COURT OF CALIFORNIA, COUNTY OF PLACER
10820 Justice Center Drive 2501 N. Lake Blvd.
P.O. Box 619072 P.O. Box 5669
Roseville, CA 95661-9072 Tahoe City, CA 96145

PETITIONER/PLAINTIFF:

RESPONDENT/DEFENDANT:

CERTIFICATE OF SATISFACTION Case Number:
OF JUDGMENT BY CLERK

Judgment was entered in this matter on _____; no renewals of judgment have been filed.

The defendant(s)/judgment debtor(s) having complied with the requirements of California
Code of Civil Procedure § 116.850, establishing that the judgment in the above-entitled case
has been satisfied, a satisfaction of that judgment is hereby entered.

seal

Dated: Jake Chatters, Clerk of the Placer County Superior Court

By: ____________________________, Deputy Clerk

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Form Adopted for Mandatory Use www.placer.courts.ca.gov Superior Court of California, County of Placer Page 1 of 2 Form No. PL-CV010 Effective 10-26-2018

SUPERIOR COURT OF CALIFORNIA, COUNTY OF PLACER

ATTORNEY OR PARTY WITHOUT ATTORNEY FOR COURT USE ONLY
(Name, State Bar Number, and Address):

TELEPHONE NO.:
FAX NO.:
EMAIL ADDRESS:
SUPERIOR COURT OF CALIFORNIA, COUNTY OF PLACER
10820 Justice Center Drive 2501 N. Lake Blvd.
P.O. Box 619072 P.O. Box 5669
Roseville, CA 95661-9072 Tahoe City, CA 96145
PETITIONER/PLAINTIFF:

RESPONDENT/DEFENDANT:

Declaration of Judgment Debtor in support of Case Number:
application to have Satisfaction of Judgment entered by
clerk (CCP § 116.850)

The undersigned declares as follows:

1. I am a judgment debtor in the above-entitled case.
2. I have made full payment of the judgment, including accrued interest and costs.
3. The judgment creditor has been requested to file an acknowledgment of satisfaction of
the judgment and refuses to do so.
4. I have attached to this declaration evidence of payment of the judgment in the form of
copies of a canceled check(s) or money order(s) written by me after the judgment made
payable to, and endorsed by, the judgment creditor.
-OR-
5. I have attached to this declaration evidence of payment of the judgment in the form of a
receipt for the full payment of the judgment written by me and 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 and that this declaration was executed by me on in
, California.

Declarant, Judgment Debtor

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Form Adopted for Mandatory Use www.placer.courts.ca.gov Superior Court of California, County of Placer Page 2 of 2 Form No. PL-CV010 Effective 10-26-2018