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

TELEPHONE NO.: FAX NO. (Optional): E-MAIL ADDRESS (Optional): ATTORNEY FOR (Name): SUPERIOR COURT OF CALIFORNIA, COUNTY OF IMPERIAL 939 West Main Street, El Centro, CA 92243 2124 Winterhaven Drive, Winterhaven, CA 92283

PLAINTIFF: DEFENDANT(S):

CASE NUMBER:

DECLARATION AND ORDER RE: SATISFACTION OF JUDGMENT CCP § 116.850

1. 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. OR Partially in the amount of $_________________. AND The judgment creditor refuses to accept any more payments.

4. 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.
5. 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.
6. An abstract of judgment A certified copy of the judgment has been recorded as follows (complete all

information for each county where recorded)
COUNTY DATE OF RECORDING INSTRUMENT NUMBER
___________________________ ___________________________ ___________________________
___________________________ ___________________________ ___________________________

NOTE: In order to release or terminate any liens listed above, a certified copy of full satisfaction of judgment must be filed with each county listed and/or the Secretary of State. FULL NAME AND LAST KNOWN ADDRESS OF JUDGMENT CREDITOR: FULL NAME AND ADDRESS OF ASSIGNEE OF RECORD, IF ANY: _____________________________________________ __________________________________________ _____________________________________________ __________________________________________ _____________________________________________ __________________________________________ I declare under penalty of perjury under the laws of the State of California that the foregoing is true and correct.

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Type or Print Name Signature of Declarant

Form Approved for Optional Use imperial.courts.ca.gov SC-03 (Adopted 01/01/22, DECLARATION AND ORDER Revised 1/01/24) RE: SATISFACTION OF JUDGMENT Page 1 of 2