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1. I am the judgment debtor in this (LA Court)

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SCLA 003 (Rev. 12/14)
DECLARATION OF JUDGMENT DEBTOR REGARDING
SATISFACTION OF JUDGMENT
Code Civ. Proc., § 116.850(c)
LASC Approved 12/08
For Optional Use
NAME, ADDRESS, AND TELEPHONE NUMBER OF PARTY:
Reserved for Clerk’s File Stamp
SUPERIOR COURT OF CALIFORNIA, COUNTY OF LOS ANGELES
SMALL CLAIMS
COURTHOUSE ADDRESS:
PLAINTIFF:
DEFENDANT:
DECLARATION OF JUDGMENT DEBTOR REGARDING
SATISFACTION OF JUDGMENT
CASE NUMBER:
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 accrued interest, costs and administrative fees, if applicable.
Partially in the amount of $__________. The judgment creditor refuses to accept any more payments.
4. I have requested that the judgment creditor file an acknowledgement of satisfaction of judgment. I made
my request orally in writing on (date) ___________. As of the date of this declaration, the judgment
creditor has failed or refused to comply with my request.
I have been unable to contact the judgment creditor because his/her present address is unknown.
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 and made payable to, and endorsed by,
the judgment creditor.
Cash, receipt for the amount paid, signed by the judgment creditor.
Other: _____________________________________________________________________.
I declare under penalty of perjury, under the laws of the State of California,
that the foregoing is true and correct.
DATE
TYPE OR PRINT JUDGMENT DEBTOR’S NAME
NOTE: THIS DOCUMENT IS NOT INTENDED FOR USE BY THE COUNTY RECORDER’S OFFICE.
CLERK’S NOTATION OF ENTRY OF SATISFACTION
Satisfaction of judgment entered in register of action pursuant to Code Civ. Proc., § 116.850, subdivision (c) as follows:
Full Satisfaction.
Partial Satisfaction in the amount of $____________________.
Clerk’s Certificate of Satisfaction of Judgment (LACIV 040) issued.
SHERRI R. CARTER, Executive Officer/Clerk
Date:
By:
, Deputy
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1. I am the judgment debtor in this (LA Court)

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Completed 12 February 2021

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