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STATE OF INDIANA COUNTY OF HAMILTON ) ) SS: ) IN THE SUPERIOR COURT NO. 5 OF HAMILTON COUNTY ____________________________________________ Judgment Creditor v. CAUSE NO. 29D05-____________________________ ____________________________________________ Judgment Debtor POST-JUDGMENT PAYMENT AGREEMENT Judgment Debtor's name: ______________________________________________________________________ Address: ___________________________________________________________________________________ Telephone: (________)______________________________ Employer: ________________________________________ _________________________________________________ Date of birth: ____________________________ Social Security number (last four digits only): SSN: XXX XX - ____ ____ ____ ____ The parties to this action have agreed that the judgment rendered in this cause in the total amount of $_______________________, plus costs, shall be paid by the Judgment Debtor as follows: (___________) within _______ days / by ____________________________________, in full. (___________) in payments of $____________________ per _______________________ beginning _____________________________ until paid. Judgment Creditor shall not execute on this judgment so long as payments are current. (___________) The parties also agree as follows: __________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ As long as payment is made as agreed, further proceedings will be withheld by the Court. ________________________________________ Judgment Creditor / Attorney ________________________________________ Judgment Debtor / Attorney Date: ___________________________________ Date: ___________________________________ APPROVAL OF SETTLEMENT The parties having filed their Post-Judgment Payment Agreement as set forth above, said Agreement is now approved and the parties are ordered to carry out the terms of their agreement. All pending hearings are vacated. ____________________________________________ Judge, Hamilton Superior Court No. 5 Rev. 9/08 PJPA American LegalNet, Inc. www.FormsWorkflow.com