ATTORNEY OR PARTY WITHOUT ATTORNEY (Name, State Bar number, and address):
FOR COURT USE ONLY
TELEPHONE NO: E-MAIL ADDRESS (Optional): ATTORNEY FOR (Name):
FAX NO. (Optional)
SUPERIOR COURT OF CALIFORNIA, COUNTY OF MENDOCINO
ADDRESS: CITY AND ZIP CODE: BRANCH NAME: CASE NUMBER: PETITIONER/PLAINTIFF: ___________________________________________ RESPONDENT/DEFENDANT: HEARING DATE: TIME: DEPT.:
NOTICED MOTION REQUESTING ENTRY OF JUDGMENT AFTER DEFAULT AND SUPPORTING DECLARATION (Small Claims)
I,
, Plaintiff/Defendant in this action, declare that: (circle)
(date) the parties stipulated that Defendant/Plaintiff perform pursuant to the 1. On terms of the agreement reached in mediation, copy attached. 2. Defendant/Plaintiff, , breached the agreement as follows:
3. On (date), I sent a copy of the document to Defendant/Plaintiff through regular mail to the address listed in the agreement. 4. Plaintiff/Defendant requests that the dismissal of this action be vacated and that the Court enter a judgment granting relief pursuant to the terms of the agreement and the breach as stated above. I declare under penalty of perjury that the foregoing is true and correct.
Date: Signature of Plaintiff/Defendant, declarant
MSC-102-local (new 0109)