Free MV3158 Certificate of Judgment - Wisconsin

CERTIFICATE OF JUDGMENT
MV3158 2/2009 s.344.05 Wis. Stats.

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Wisconsin Department of Transportation Uninsured Motorist Unit PO Box 7983 Madison, WI 53707-7983 Telephone: 608-266-1249 Facsimile (FAX): 608-267-0606 Teletypewriter for the Deaf (TTY): 608-266-0824

State of Wisconsin

County

Court

PLAINTIFF Name and Mailing Address

DEFENDANT(S) Name(s) and Mailing Address(es)

vs.

Court Clerk Name City/Town/Village Accident Date

Defendant Street Address City, State, ZIP Code Driver License Number Defendant Birth Date

Second Defendant Street Address City, State, ZIP Code Driver License Number Defendant Birth Date

I, the undersigned Clerk of Court, certify that the attached copy of a judgment is a true and correct copy of the original judgment rendered by this court and is certified to the Administrator of the Division of Motor Vehicles at Madison, Wisconsin, pursuant to s.344.05 Wisconsin Statutes. I certify that the judgment is $500 or more and is for damages, excluding costs and disbursements, arising from a motor vehicle accident occurring on the date specified above. I certify that the judgment has become final by expiration of the statutory appeal period without an appeal having been perfected during such appeal period, or the judgment has been appealed with final affirmation on appeal. I certify that the judgment has not been satisfied of record during the statutory appeal period plus 30 days grace period and that this certification to the Administrator of the Division of Motor Vehicles for suspension of licenses under s.344.05 Wisconsin Statutes has been requested by the judgment creditor or the attorney of record.
Court Seal

In Testimony, I give my signature and affix the seal of the Court.

X
(Clerk of Court) (Date)

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