California > Local County > Santa Cruz > Small Claims
Declaration And Order Re Mediated Agreement Default SUPSC-024 - California
| Declaration And Order Re Mediated Agreement Default Form. This is a California form and can be used in Small Claims Santa Cruz Local County . |
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Name and Address of Party: FOR COURT USE ONLY Telephone No: Plaintiff Defendant Other: SUPERIOR COURT OF CALIFORNIA, COUNTY OF SANTA CRUZ Small Claims Division 1 Second Street, Room 300 Watsonville, CA 95076 PLAINTIFF(S): DEFENDANT(S): DECLARATION AND ORDER RE: MEDIATED AGREEMENT DEFAULT CASE NUMBER: I am the (check one) 1. Plaintiff or Defendant in this case and I declare: I am attaching a copy of the mediation agreement that we reached in this case on (insert date): ______________________________________________. The (check one) Plaintiff or Defendant has defaulted on this agreement. The payment or 2. action due on (insert date): ____________________________________ has not been received. 3. 4. 5. Prior payments totaling $__________________________ were received. The outstanding balance or action is $__________________________________________________. 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: _________________________________________________________________________________ _________________________________________________________________________________ _________________________________________________________________________________ SUP CV024 [New 01/02/12] Optional Declaration and Order Re: Mediated Agreement Default Page 1 of 2 American LegalNet, Inc. www.FormsWorkFlow.com SHORT TITLE: CASE NUMBER: I declare under penalty of perjury under the laws of the State of California that the foregoing is true and correct. Date: ________________________________ _____________________________________ 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/Commissioner of the Superior Court SUP CV024 [New 01/02/12] Optional Declaration and Order Re: Mediated Agreement Default Page 2 of 2 American LegalNet, Inc. www.FormsWorkFlow.com
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