SC-223 Declaration of Default in Payment of Judgment

Declaration of Default
in Payment of Judgment
(Small Claims)
Important: Read the other side before you fill out this form or if it was mailed
to you. If you are the judgment debtor named in
and you disagree with this
Declaration of Default in Payment of Judgment, you may file Response to
Declaration of Default in Payment of Judgment (Form SC-224) within 10 days
after the declaration was mailed to you.
My name is:
The judgment debtor who has not made payments as the court ordered is
(complete a separate form for each judgment debtor who has not paid as
ordered):
Name:
SC-223, Page 1 of 2
Judicial Council of California, www.courts.ca.gov
New July 1, 2013, Op ti on al For m
Code of Civil Proce dure, § 116.620;
Cal. Rules of Court, rule 3.2107
SC-223
Declaration of Default
in Payment of Judgment
Other payment schedule (specify):
b.
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:
On (date): the court ordered that the judgment debtor named in
must pay me, or someone who assigned the judgment to me, principal,
prejudgment interest, and costs in the total amount of $ .
Payments of $ on the day of each
(month, week, other):
starting (date): , until (date of final payment): ; amount of final payment: $
a.
Mailing address:
I am asking the court to order that the remaining balance of a small claims
judgment is now due and collectible because payments were not made as
the court ordered.
Mailing address:
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
On (date): the court ordered that the judgment debtor named in may pay the judgment described
in
as follows:
The payments listed below, and no others, hav e been made on the judgment described in .
Date Amount Date Amount Date Amount Date Amount
Check here if there is not enough space below. List the date and amount of each payment on a separate page and write
“SC-223, Item 5” at the top.
The total amount of the payments that have been made on the judgment described in is $ ,
and the balance due, without adding any interest after the judgment, is $ .
I request interest on the judgment, in the amount of $ , calculated as follows:
Check here if there is not enough space below. Explain how you calculated interest on a separate page and write
“SC-223, Item 7” at the top.
Phone: E-mail (optional):
Phone: E-mail (optional):
To keep other people from
seeing what you entered on
your form, please press the
Clear This Form button at the
end of the form when finished.
Page 1/2
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