Santa Cruz — SUPSC-024

Source: https://www.santacruz.courts.ca.gov/sites/default/files/pdfs/POST%20%28WEB%29%20SUPSC%20024%20Declaration%20Re%20Mediated%20Agreement%20Default.pdf

SUPSC 024 PARTY INFORMATION (Name and address): FOR COURT USE ONLY NAME: ADDRESS: CITY, STATE, ZIP:

TELEPHONE NO: FAX NO. (Optional): EMAIL ADDRESS (Optional):

Plaintiff Defendant Other:

SUPERIOR COURT OF CALIFORNIA COUNTY OF SANTA CRUZ Small Claims Division Watsonville Branch 1 Second Street, Room 300 Watsonville, CA 95076 PLAINTIFF/PETITIONER: vs. DEFENDANT/RESPONDENT: DECLARATION AND ORDER RE: CASE NUMBER: MEDIATED AGREEMENT DEFAULT

I am the (check one) Plaintiff or Defendant in this case and I declare:

1. I am attaching a copy of the mediation agreement that we reached in this case on (insert date): ______________________________________________.

2. The (check one) Plaintiff or Defendant has defaulted on this agreement. The payment or action due on (insert date): ____________________________________ has not been received.

3. Prior payments totaling $__________________________ were received.

4. The outstanding balance or action is $__________________________________________________.

5. Therefore I am requesting that Judgment be entered in this case against (insert name(s)): _______________; in the amount of $.

6. I am sending a copy of this request to all parties in this case by regular mail addressed as follows:

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Form Adopted for OPTIONAL USE DECLARATION AND ORDER RE: Page 1 of 2 Superior Court of Santa Cruz County MEDIATED AGREEMENT DEFAULTSUPSC 024 01/01/20

PLAINTIFF/PETITIONER: CASE NUMBER: DEFENDANT/RESPONDENT:

I declare under penalty of perjury under the laws of the State of California that the foregoing is

true and correct.

Date: ___________________

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Print your name Sign here

(check one) Plaintiff or Defendant

ORDER
IT IS ORDERED that the Clerk shall prepare a Notice of Entry of Judgment in the amount of

$______________________ principal and $________________________ costs.

Date: ________________ _________________________________________ Judge of the Superior Court

Form Adopted for OPTIONAL USE DECLARATION AND ORDER RE: Page 2 of 2 Superior Court of Santa Cruz County MEDIATED AGREEMENT DEFAULTSUPSC 024 01/01/20