Name and Address of Court:
SMALL CLAIMS CASE NO.:
DEFENDANT/DEMANDADO (Name, street address, and telephone number of each):PLAINTIFF/DE MANDANTE (Name, street address, and telephone number of each):
Telephone No.:Telephone No.:
See attached sheet for additional plaintiffs and defendants.
ORDER TO PRODUCE STATEMENT OF ASSETS
AND TO APPEAR FOR EXAMINATION
1. TO JUDGMENT DEBTOR (name):
2. YOU ARE ORDERED
a. to pay the judgment and file proof of payment (a canceled check or money order or cash receipt, and a written declaration that
shows full payment of the judgment, including postjudgment costs and interest) with the court before the hearing date shown in
the box below, OR
DATE DAY TIME
PLACE COURT USE
If you fail to appear and have not paid the judgment, in-
cluding postjudgment costs and interest, a bench warrant
may be issued for your arrest, you may be held in con-
tempt of court, and you may be ordered to pay penalties.
Si usted no se presenta y no ha pagado el monto del fallo
judicial, inclusive las costas e intereses posterlores al
fallo, la corte puede expedir una orden de detencion contra
usted, declararle en desacato y ordenar clue pague multas.
3. This order may be served by a sheriff, marshal, or registered process server.
(SIGNATURE OF JUDGE)
APPLICATION FOR THIS ORDER
applies for an order requiringA. Judgment creditor (the person who won the case) (name):
judgment debtor (the person or business who lost the case and owes money) (name):
to (1) pay the judgment or (2) personally appear in this court with a completed Judgment Debtor's Statement of Assets (form
SC-133), explain why judgment debtor did not pay the judgment or complete and mail form SC-133 to judgment creditor within
30 days after the Notice of Entry of Judgment was mailed or handed to judgment debtor, and answer questions about judgment
debtor's income and assets.
B. Judgment creditor states the following:
(1) Judgment debtor has not paid the judgment.
(2) Judgment debtor either did not file an appeal or the appeal has been dismissed or judgment debtor lost the appeal.
(3) Judgment debtor either did not file a motion to vacate or the motion to vacate has been denied.
(4) More than 30 days have passed since the Notice of Entry of Judgment form was mailed or delivered to judgment debtor.
(5) Judgment creditor has not received a completed Judgment Debtor's Statement of Assets form from judgment debtor.
(6) The person to be examined resides or has a place of business in this county or within 150 miles of the place of examination.
I declare under penalty of perjury under the laws of the State of California that the foregoing is true and correct.
(See Instructions on reverse)
(TYPE OR PRINT NAME)
The county provides small claims advisor services free of charge.
APPLICATION AND ORDER TO PRODUCE STATEMENT
OF ASSETS AND TO APPEAR FOR EXAMINATION
Code of Civil Procedure §§ 11 6.820,116.830
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
b. to (1) personally appear in this court on the date and time shown in the box below, and (2) bring with you a completed Judgment
Debtor's Statement of Assets (form SC-133). (At the hearing you will be required to explain why you did not complete and mail
form SC-133 to judgment creditor within 30 days after the Notice of Entry of Judgment (form SC-130) was mailed or handed to
you by the clerk, and to answer questions about your income and assets.)
Form Adopted for Mandatory Use
Judicial Council of California
SC-134 [Rev. January 1, 2007]
Page 1 of 2
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