Read both sides of Form SC-220, Request to Make Payments, before you fill out
this form.
My name is:
The judgment debtor who asked to make payments in this case is:
SC-221
Judicial Council of California, www.courts.ca.gov
Rev. July 1, 2013, Optional Form
Code of Civil Procedure, § 116.620, Cal. Rules of Court, rule 3.2107
SC-221
Response to Request to Make
Payments
Response to Request to Make Payments
(Small Claims)
Other payment schedule (specify):
b.
c.
The total amount of payments is $ , which includes interest on the unpaid balance of the judgment.
The actual amount of that interest may be different if the payments are made late or early.
Attach a page that shows how you calculated the interest and write “SC-221, Item 4c” at the top.
Clerk stamps here when form is filed.
Case Number:
Fill in your case number and case name:
Fill in the court name and street address:
Superior Court of California, County of
Case Name:
Phone:
(Name):
I agree to accept the payment plan in the Request.
I agree to accept a different payment plan
(check and complete all that apply):
Payments of $ ,
a.
d.
The total amount of payments is the same as the judgment. If all payments are made in full and on time, no
interest will be owed on the judgment, and the judgment will be paid in full.
Mailing address:
Important! If any payment is not made in full and on time, you may notify the court to cancel
the payment plan and the entire unpaid balance will become due and collectible.
Starting (date): , until (date of final payment): ;
I am a judgment creditor in this small claims case.
e.
Other
(specify):
I do not agree to accept payments because (explain):
If your answer will not fit in the space below, check this box and attach your answer on a separate sheet of paper.
Write “SC-221, Item 5” at the top.
on the day of each (month, week, other):
I declare under penalty of perjury under the laws of the State of California that the information above is true and correct.
Date:
Type or print your name Sign here
amount of final payment: $
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