Form Approved for Optional Use
Judicial Council of California
CR-111/JV-791 [Rev. July 1, 2015]
CR-111/JV-791
ATTORNEY OR PERSON WITHOUT ATTORNEY (Name, State Bar number, and address):
FOR RECORDER'S USE ONLY
FOR COURT USE ONLY
Page 1 of 2
ABSTRACT OF JUDGMENT—RESTITUTION
The
Driver's license no. [last 4 digits] and state:
Judgment debtor's
b.
Social security no. [last 4 digits]:c.
Date of birth:d.
1.
applies for an abstract of judgment and represents the following:
ABSTRACT OF JUDGMENT—RESTITUTION
Recording requested by and return to:
E-MAIL ADDRESS (Optional):
ATTORNEY FOR:
JUDGMENT
CREDITOR
ASSIGNEE OF
RECORD
judgment creditor
assignee of record
other (specify):
a.
Name and last known address
Unknown
Unknown
Unknown
(SIGNATURE OF APPLICANT OR ATTORNEY)
(TYPE OR PRINT NAME)
Date:
ON INFORMATION AND BELIEF
Penal Code, §§ 1202.4(i), (m), 1214;
Welfare and Institutions Code, § 730.6(i), (r);
Code of Civil Procedure, § 674
www.courts.ca.gov
Amended
CASE NAME:
SUPERIOR COURT OF CALIFORNIA, COUNTY OF
BRANCH NAME:
CITY AND ZIP CODE:
STREET ADDRESS:
MAILING ADDRESS:
FAX NO. (Optional):
TELEPHONE NO.:
CASE NUMBER:
CASE NUMBER:
CASE NAME:
CR-111/JV-791
I certify that the following is a true and correct judgment entered in this action.
2.
This abstract of judgment was issued on (date):
7.
Total amount of judgment as entered or last renewed: $
6.
Judgment entered on (date):
5.
Judgment debtor (full name as it appears in judgment):
4.
Judgment creditor (name):
3.
whose address or whose attorney's address appears on this form above the
court's name.
A stay of enforcement was ordered on: and is effective until:
A stay of enforcement was not ordered.
[SEAL]
CERTIFICATION
Clerk, by , Deputy
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ABSTRACT OF JUDGMENT—RESTITUTION
CR-111/JV-791 [Rev. July 1, 2015]
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