______________________________________________________________________________ UNITED STATES DISTRICT COURT SOUTHERN DISTRICT OF CALIFORNIA ______________________________________________________________________________ ) ) Case Number: ) )_______________________________________________ ) AFFIDAVIT AND REQUEST FOR ISSUANCE ) OF WRIT OF EXECUTION ______________________________)_______________________________________________ State of California, County of _____________________________________________________ I, ____________________________ hereby state under penalty of perjury that, 1. Judgment for $ __________________ was entered on ___________________ in the docket of the above-entitled action in favor of (Date) ________________________________________________________________________ as Judgment Creditor, and against ________________________________________________________________________ as Judgment Debtor (If a registered Judgment, fill in below) Said Judgment was registered herein under title 28, U.S. Code, Section 1963, being a Judgment which was obtained in Civil Case No. ___________________________ in the United States District Court for the _________________________ District of __________________________ and which has become FINAL. 2. I am the Judgment Creditor, or the attorney for said Judgment Creditor, and request issuance of a Writ of Execution on the Judgment. (OVER) 2001 © American LegalNet, Inc. ______________________________________________________________________________ AFFIDAVIT AND REQUEST FOR ISSUANCE OF WRIT OF EXECUTION 3. ACCRUED since the entry of judgment are the following sums: $________________________ accrued interest, computed at ______________% (See note) $________________________ accrued costs 4. CREDIT must be given for payments and partial satisfactions in the total amount of : $_________________________ which is to be first credited against the judgment as entered still remaining due and bearing interest at _____________________% in the amount of $______________________ per day from this date. I declare under the penalty of perjury that the foregoing is true and correct. Executed at:______________________________________________________________ State of: __________________________________ this ______________________ date of _________________________ 20 _____________. ________________________________ (Signature) NOTE: JUDGMENTS REGISTERED UNDER 28 U.S.C. 1963 BEAR THE RATE OF INTEREST OF THE DISTRICT OF ORIGIN. 2001 © American LegalNet, Inc.