Preview
£7)
Olerk stamps here when form is filed.
SC-ZZO Request to Make Payments
Read the other side before you fill out this form.
6) I am asking for p ission to pay my small claims judgment 1n payments.
My name is: Egg/I Mfltfl%flt 7‘7”n fl/Mfl/ ”@4917
(I
Mailing address: ([303 Ah dip yZ/w/e 1:!- $1.?
fig (p a 709 5/4. 39%:—
Phone: 4//C- .305!- 5/53
Fill in the court nglgzé and street address:
® On (date):flég/é 1 / Z ,the court made the decision (judgment) that:
15-
. V . .
Superior Court of California, County 0f
Iowe (total amount): $ /2 San Mateo
To (name ofpartyyou mustpay): Ball {ZN-M (In. Ka/rp ' 400 County Center
Mailing address: I/ 30 5-574 gfwoef 4341/ Redwood City, CA 94063—1655
OaKIa/La/ an, 46/63»:
Phone: ‘f/J" Zéfl -1576/? Fill in your case number and case name:
Case Number:
® I am asking for permission to make payments, instead of paying the full
amount all at once, because (explain):
Case Name.
/ :1 113557.50033 5
‘
El Ifyour answer will notfit in the space below, check this box and
attach your
answer on a separate sheetlofpaper. Write ”-SC 220 Item 3 ’at the top.
466 are Elana mar/n3 Cfllrflat/d/ afg/ flare 04!} fl/ze 75906:.
4 are/1e 045a Mm My nag/a r’n war. 4 ca... rad/fee sap/”mg
1am Jesa Wee/'07 [aria anon/17‘ fix: &a/" 759/»?q Tia/7K c/ou.
@ I ask the court to allow me to make payments on the following terms (check and complete all that apply):
21.
2f, Payments of $ Z/ Z: ,on the / S7" day of each (month week, other): /%Q/n 7%
Q5441},
Starting (date): until (dateoffinal payment) [Q/Z/ ?; amount of final payment $ /Z 15’
0‘
- [:1 Other payment schedule (specify).
c. [I The total amount of payments is $ , which includes interest on the unpaid balance of the judgment.
The actual amount of that interest may be different if the payments are made late or early.
Attach a page that shows how you calculated the interest and write “SC—220, Item 4c ” at the top.
d. [I The total amount of payments is the same as the judgment. Ifall payments are made in full and on time, no
interest will be owed on the judgment, and the judgment will be paid in filll.
e. [I Other (specifiz):
Warning! If any payment is not made in full and on time, the judgment creditor may notify the court
to cancel the payment plan and the entire unpaid balance will become due and collectible.
I declare under penalty of perjury under the laws of the State of California that the information above is true and correct.
Date: /3
£42350: M
Type or prmt your name
0: 62 fltf"9fllr/L > jig/2%
Sign here
éilfiflmfilE‘Sti‘li’nmalaemw“”s'°a'g°v Reques" to Make P< 17— SCS— oases ,
'
80-220, Page 1of2
dcniil
Cod-e
(Small Claims)
Procedure. § 116.620. Cal. Rules of Court. rule 3.2107 $0220
Request to Pay Judgment In lnstallments
llimmmm lllllllll
Payments in SmallClaims'Cases
General Information
If the court ordered you to pay money, you can ask If the court ordered someone to pay you money,
”thecourt for permission to'make payments. Here’s how: and that person has filed a Request to Make Payments...
.
'
Read thrs ‘E'fform-é “3? ”2,112.35
. Read this form and the Request. ~
- If you agree with the Request, you do not need to do
. Fill out Form SC-220 Request to Make Payments.
Fill out one form fer eaCh plaintiff or defendant anything. \
(judgment creditor) you want to make payments to. - If you do not agree With the Request or you want to
be paid interest, file a Response within 10 days
3 Fill OLIt Form EJ-165, Financial Statement.
after the court clerk mailed the Request to you.
. File your completed forms with the small claims (This date is on the Clerk’sCertificat‘e of Mailing.)If you
court clerk. do not do this, the court may allow the person who
owes you money to make payments. And, you may
The court will mail all other plaintiffs and defendants lose your rights to collect interest on the judgment.
in the case copies of your Request to Make Payments
:nd Financial Statement, and a blank Form 30— 221 To file your Responsei
Pésponse to Request to Make Payments. - Fill out Form SC-221, Response to Request to Make
Payments.
The other parties will have 10 days to file a - Have your Response served on all other plaintiffs and
Response. Then, the court will mail all plaintiffs and defendants'In your case. (See Form 80- 112A, Proof of
tefendants in the case: Service By Mail.)
- A decision on the Request to Make Payments or
- File your Response and Proof of Service with the small
. A notice to go to a hearing. claims court clerk.
Answers to Common Qiéstions
’ ' K
,
»
When is the judgment due? interest. If a partial payment is received, the money is
. Unless the court orders otherwise, small claims judgments applied first to unpaid interest and then to unpaid principal.
are due immediately. If the judgment is not paid in full
When the court allows payments, the court often does not
within 30 days, the judgment creditor (person to whom the order any interest, as long as all payments are made in full
'
money is owed), can take legal steps to collect any .unpaid and on time; Unless the creditor asks for interest to be
amount. (Collection may be postponed if an appeal or a included in the order allowing payments, the creditor may
_
request to vacate (cancel) or correct the judgment is filed.) lose any claims'for interest. But,if the debtor does not make
Ban the judgment debtor make payments? full payments on time, interest on the missed payment or
A party who was ordered to pay a small claims judgment the entire unpaid balance might become due and collectible.
{the judgment debtor) can ask the court for permission to How do I calculate interest? ,.
'
make payments. If the Court agrees, the party who Is owed If you are proposing a payment schedule that includes
money (the judgment creditor) cannot take any other steps interest, you need to itemize the principal and interest for
1:) collect the money as long. as the payments are made each payment. To do this, you can search on the Internet
on time. for "free amortization calculator." Enter the total amount of
Is interest added after the judgment? the judgment as the principal, the interest rate of 10
QI'Iterest (1 0 percent per year) is usually added to the percent per year, the frequency of payments (monthly,
aaid amount of the judgment from the date the judgment weekly, etc.), and the number or length of payments. Print
In full. Interest can only be
is entered until it is paid the results showing the payment amount and how each
charged on the unpaid amount of the judgment (the payment is divided between principal and interest. Attach
principal); interest cannot be charged on any unpaid this to your Request or Response.
Need help?
For free helP , contact your county’s small claims advisor:
[local info here]
'
.‘
Or go to “County-Specific Court'Infogmation’: atww. courts. ca.g0v/selfhelp-smallclaz'ms.him
36-220, Page 2 of2
Fev. July 1 , 2013
Request to Make Payments
(Small Claims)
, x, /"‘\
‘ A]
} ‘\\l‘lI
WG-007IEJ-165
SHORT TITLE: LEWING OFFICER FILE NO. COURT CASE NO.
FINANCIAL STATEMENT
(Wage Garnishment—Enforcement of Judgment
NOTE: if you are married, this form must be signed by your spouse unless you and your spouse are living separate and
apart. If this form is not signed by your spouse, check the applicable box on the reverse in item 9.
.1. The following persons other than myself depend, in whole or in part. on me or my spouse for support:
MONTHLY TAKE-HOME
NAME AGE RELATIONSHIP TO ME INCOME & SOURCE
a. Le I; 5L KAQCAQ 7/73/41”: 2] Spouse
lépa
c.
d.
e.
2. My monthly income
b. My payroll deductions are (specify purpose and amount):
(1) Federal and state withholding.
FICA, and SDI ......... $
(2) $'
(3) -
$
(4) » 35
~-
My TOTAL payroll deduction amount is {add (1) through (4)).- ........ ....I .............................
.
_.c. My monthly take-home pay is (a minus b): .................................
d. Other money iget each month from (specify source):
firm/VH4 Mpg/jag JZC’ 3.175???“ ......... d.$
e. TOTAL MONTHLYINCOME //fl0
(0 plus d) ..................................................................................
e. $
3. I,my spouse, and my other dependents own the following property;
a. 3a. $ 2 000
Cash .......................................................................................................................................
b. Checking, savings, and credit union accounts (list banks): -
(1)
(2)
(02565 fin” Q4: “Jo/x: f”- $ Z9570
$
(3) $ b.$
c. Cars,
$£¢L
other vehicles, and boat equity (list make, yearof each):
~
(1)
<2)
7&w
Muck “I
game!
S’L/Zo/
(3% mag/L
/V/"’/€” $ $000
(3) $ c.$
d. Real estate equity ...... /.I./.O.AIE .................... ........................................................................... ..
.
d.$
e. Other personal property (jewelry, furniture, furs, stocks, bonds, etc.) (list separate/y):
MID/WE
e.$
Page1of 2
Form Adopted by the Judicial Council
of Caiifomia FINANCIAL STATEMENT Code of Civil Procedure. §§ 706.124. 703.530
WWW/EM“Walkman/1.20071 www.courtinfo.m.gov
(Wage Garnishment—Enforcement of Judgment)
WG-007IEJ-1 65
'
‘ LEWING OFFICER FILE NO. COURT CASE NO.
SHORT TlTLE:
=1. The monthly expenses for me, my spouse, and my other dependents
a.
‘
4 a. $ 200 0
............................................
Rent or house payment and maintenance .....................................
b. Food and household supplies .......... b $ 62g
.....................................................................
0. Utilities and telephone ........
-
0. $ 2 5: 0
..................................................................................
d. ............................................................................
Clothing .........................
-.
d. $ 2 Q0
payments
e‘. $ .-
.....................................................................................................
e. Medical and dental
f. etc.)
Insurance (life, health, accident,
'
I _
f. $ 5m
.......................................................................................
$ —-
School, child care ................ .......................................................................................................
g .
9.
h $
'
-
Child, spousal support‘(prior marriage) ......................................................................................
1a 0
h.
carpayments initem 5) ..............$
Transportation & auto expenses (insurance, gas, repair) (list
1
l. '
below in item j.
..................................................
$
j. installment payments (insert total and itemize 5)
k. $ —
k. Laundry and cleaning ......................................................................................................
l $ —-
l. Entertainment .............................................................................................................................
m. Other (specify):
m. $ 2 r29
n. TOTAL MONTHLY EXPENSES (add a through m):
n. $ 3 KW 0
................................................................
5. I, my spouse, and my other dependents owe the following debts: OWED BY
CREDITOR'S NAME FOR
~
MO. PAYMENTS BALANCE OWED (State person's name)
I? u 1‘0
__ Car
:
14/90 ’
”owe
-
‘
all; '
Ban K
, _
ase 19444”
flmaaone
6/0/6041 13:90 {or}: . .
.-
61’
”Wt"
fled/9U; )0,» #20694 Zfé’ (317‘3
tuition, expenses for recent family
6. Other facts which support this Claim of Exemption (i.e., unusual medical needs, school
expenses
emergencies, _or other unusual tohelp yourcreditorand thejudge understand your budget) (describe): (If more space is
needed, attach page labeled Attachment 6. )
7. [ju/e
item 1 (specify each person's name and monthly
lax/e '
(My,
amount):
9/ 5,!ana/
.
spouse or dependents named in
An earnings withholding order is now in effect with respect to my earnings orthose of my
Zy'a.
z 0/(;%§ ya
spouse or dependents named in
3. [:1 A wage assignment for support is now in effect with respect to my earnings or those of my
person's
item 1 (specify each name and monthly amount):
3. Ifi
[:1
My spouse has signed below.
lhave no spouse.
'
1:]
/w
My spouse and I are living separate and apart.
is true and correct.
1declare under penalty of perjury under the laws of the State of California that the foregoing
Date: ‘
(Em/QM {lac/Za/flq/L } ;
Lie/Z a
(TYPEOR PRINTNAME)
('54. amt/ma
.
.
-
D
',//6/‘’\..//
'
SIGNATl/JBE)
z .
_ M“
(SIGNATURE OF SPOUSE)
(TYPE OR PRINT NAME OF SPOUS
Page 2 of 2
NG—007IEJ-165 [Rev. January 1,2007] . FINANCIAL STATEMENT
(Wage Garnishment—Enforcement of Judgment)
/*\ /“x
x
\- j t ,4, /
.-
Response to Request to Make .
Clerkstamps here when form is filed.
SC'221
.
Payments
Read both sides of Form SC—220, Request to Make Payments, before you till out
this form. I
G) I am a judgment creditor in this small claims case.
My name is:
Mailing address:
Phone:
Fill in the court name and street address:
Superior Court Of California, County 0f
® The judgment debtor who asked to make payments in this case is: ,
(Name): ,
>
San Mateo
400 County Center
Redwood City, CA 94063
® [I I agree to accept the payment plan in the Request.
Fill in your case number and case name:
@ I agree to accept a different payment plan (check and complete all that apply): Case Number:
a. El Payments of $' A Case Name:
on the day of each (month, week, other):
Starting (date): , until(dateoffinal payment):
amount of final payment: $
b-_El Other payment schedule (Specifil):
0. CI The total amount of payments is $ , which includes interest on the unpaid balance of the judgment.
The actual amount of that interest may be different if the payments are made late or early.
I
Attach a page that shows how you calculated the interest and write “SC-221, Item 4c” at the top.
d. [I The total amount of payments is the same as the judgment. Ifall payments are made in full and on time, no
interest will be owed on the judgment, and the judgment will be paid in full.
6. C] Other (specijy):
Important! If any payment is not made in full and on time, you may notify the court to cancel
the payment plan and the entire unpaid balance will become due and collectible.
® I] I do not agree to accept payments because (explain):
I] Ifyour answer will not fit
"
in the space below, check this box and attach your answer on a separate sheet ofpaper.
Write “SC-221, Item 5 at the top.
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
'' '
to
'I lie , . r!scaaov
..
Response to Request to Make Payments so _221
éi‘lfli'152’,”231§_OSEOElam“
(Small Claims)
Code ofCivil Procedure, 5 116.620. Cal. Rules of Court. rule 3.2107
Preview
£7) Olerk stamps here when form is filed. SC-ZZO Request to Make Payments Read the other side before you fill out this form. 6) I am asking for p ission to pay my small claims judgment 1n payments. My name is: Egg/I Mfltfl%flt 7‘7”n fl/Mfl/ ”@4917 (I Mailing address: ([303 Ah dip yZ/w/e 1:!- $1.? fig (p a 709 5/4. 39%:— Phone: 4//C- .305!- 5/53 Fill in the court nglgzé and street address: ® On (date):flég/é 1 / Z ,the court made the decision (judgment) that: 15- . V . . Superior Court of California, County 0f Iowe (total amount): $ /2 San Mateo To (name ofpartyyou mustpay): Ball {ZN-M (In. Ka/rp ' 400 County Center Mailing address: I/ 30 5-574 gfwoef 4341/ Redwood City, CA 94063—1655 OaKIa/La/ an, 46/63»: Phone: ‘f/J" Zéfl -1576/? Fill in your case number and case name: Case Number: ® I am asking for permission to make payments, instead of paying the full amount all at once, because (explain): Case Name. / :1 113557.50033 5 ‘ El Ifyour answer will notfit in the space below, check this box and attach your answer on a separate sheetlofpaper. Write ”-SC 220 Item 3 ’at the top. 466 are Elana mar/n3 Cfllrflat/d/ afg/ flare 04!} fl/ze 75906:. 4 are/1e 045a Mm My nag/a r’n war. 4 ca... rad/fee sap/”mg 1am Jesa Wee/'07 [aria anon/17‘ fix: &a/" 759/»?q Tia/7K c/ou. @ I ask the court to allow me to make payments on the following terms (check and complete all that apply): 21. 2f, Payments of $ Z/ Z: ,on the / S7" day of each (month week, other): /%Q/n 7% Q5441}, Starting (date): until (dateoffinal payment) [Q/Z/ ?; amount of final payment $ /Z 15’ 0‘ - [:1 Other payment schedule (specify). c. [I The total amount of payments is $ , which includes interest on the unpaid balance of the judgment. The actual amount of that interest may be different if the payments are made late or early. Attach a page that shows how you calculated the interest and write “SC—220, Item 4c ” at the top. d. [I The total amount of payments is the same as the judgment. Ifall payments are made in full and on time, no interest will be owed on the judgment, and the judgment will be paid in filll. e. [I Other (specifiz): Warning! If any payment is not made in full and on time, the judgment creditor may notify the court to cancel the payment plan and the entire unpaid balance will become due and collectible. I declare under penalty of perjury under the laws of the State of California that the information above is true and correct. Date: /3 £42350: M Type or prmt your name 0: 62 fltf"9fllr/L > jig/2% Sign here éilfiflmfilE‘Sti‘li’nmalaemw“”s'°a'g°v Reques" to Make P< 17— SCS— oases , ' 80-220, Page 1of2 dcniil Cod-e (Small Claims) Procedure. § 116.620. Cal. Rules of Court. rule 3.2107 $0220 Request to Pay Judgment In lnstallments llimmmm lllllllll Payments in SmallClaims'Cases General Information If the court ordered you to pay money, you can ask If the court ordered someone to pay you money, ”thecourt for permission to'make payments. Here’s how: and that person has filed a Request to Make Payments... . ' Read thrs ‘E'fform-é “3? ”2,112.35 . Read this form and the Request. ~ - If you agree with the Request, you do not need to do . Fill out Form SC-220 Request to Make Payments. Fill out one form fer eaCh plaintiff or defendant anything. \ (judgment creditor) you want to make payments to. - If you do not agree With the Request or you want to be paid interest, file a Response within 10 days 3 Fill OLIt Form EJ-165, Financial Statement. after the court clerk mailed the Request to you. . File your completed forms with the small claims (This date is on the Clerk’sCertificat‘e of Mailing.)If you court clerk. do not do this, the court may allow the person who owes you money to make payments. And, you may The court will mail all other plaintiffs and defendants lose your rights to collect interest on the judgment. in the case copies of your Request to Make Payments :nd Financial Statement, and a blank Form 30— 221 To file your Responsei Pésponse to Request to Make Payments. - Fill out Form SC-221, Response to Request to Make Payments. The other parties will have 10 days to file a - Have your Response served on all other plaintiffs and Response. Then, the court will mail all plaintiffs and defendants'In your case. (See Form 80- 112A, Proof of tefendants in the case: Service By Mail.) - A decision on the Request to Make Payments or - File your Response and Proof of Service with the small . A notice to go to a hearing. claims court clerk. Answers to Common Qiéstions ’ ' K , » When is the judgment due? interest. If a partial payment is received, the money is . Unless the court orders otherwise, small claims judgments applied first to unpaid interest and then to unpaid principal. are due immediately. If the judgment is not paid in full When the court allows payments, the court often does not within 30 days, the judgment creditor (person to whom the order any interest, as long as all payments are made in full ' money is owed), can take legal steps to collect any .unpaid and on time; Unless the creditor asks for interest to be amount. (Collection may be postponed if an appeal or a included in the order allowing payments, the creditor may _ request to vacate (cancel) or correct the judgment is filed.) lose any claims'for interest. But,if the debtor does not make Ban the judgment debtor make payments? full payments on time, interest on the missed payment or A party who was ordered to pay a small claims judgment the entire unpaid balance might become due and collectible. {the judgment debtor) can ask the court for permission to How do I calculate interest? ,. ' make payments. If the Court agrees, the party who Is owed If you are proposing a payment schedule that includes money (the judgment creditor) cannot take any other steps interest, you need to itemize the principal and interest for 1:) collect the money as long. as the payments are made each payment. To do this, you can search on the Internet on time. for "free amortization calculator." Enter the total amount of Is interest added after the judgment? the judgment as the principal, the interest rate of 10 QI'Iterest (1 0 percent per year) is usually added to the percent per year, the frequency of payments (monthly, aaid amount of the judgment from the date the judgment weekly, etc.), and the number or length of payments. Print In full. Interest can only be is entered until it is paid the results showing the payment amount and how each charged on the unpaid amount of the judgment (the payment is divided between principal and interest. Attach principal); interest cannot be charged on any unpaid this to your Request or Response. Need help? For free helP , contact your county’s small claims advisor: [local info here] ' .‘ Or go to “County-Specific Court'Infogmation’: atww. courts. ca.g0v/selfhelp-smallclaz'ms.him 36-220, Page 2 of2 Fev. July 1 , 2013 Request to Make Payments (Small Claims) , x, /"‘\ ‘ A] } ‘\\l‘lI WG-007IEJ-165 SHORT TITLE: LEWING OFFICER FILE NO. COURT CASE NO. FINANCIAL STATEMENT (Wage Garnishment—Enforcement of Judgment NOTE: if you are married, this form must be signed by your spouse unless you and your spouse are living separate and apart. If this form is not signed by your spouse, check the applicable box on the reverse in item 9. .1. The following persons other than myself depend, in whole or in part. on me or my spouse for support: MONTHLY TAKE-HOME NAME AGE RELATIONSHIP TO ME INCOME & SOURCE a. Le I; 5L KAQCAQ 7/73/41”: 2] Spouse lépa c. d. e. 2. My monthly income b. My payroll deductions are (specify purpose and amount): (1) Federal and state withholding. FICA, and SDI ......... $ (2) $' (3) - $ (4) » 35 ~- My TOTAL payroll deduction amount is {add (1) through (4)).- ........ ....I ............................. . _.c. My monthly take-home pay is (a minus b): ................................. d. Other money iget each month from (specify source): firm/VH4 Mpg/jag JZC’ 3.175???“ ......... d.$ e. TOTAL MONTHLYINCOME //fl0 (0 plus d) .................................................................................. e. $ 3. I,my spouse, and my other dependents own the following property; a. 3a. $ 2 000 Cash ....................................................................................................................................... b. Checking, savings, and credit union accounts (list banks): - (1) (2) (02565 fin” Q4: “Jo/x: f”- $ Z9570 $ (3) $ b.$ c. Cars, $£¢L other vehicles, and boat equity (list make, yearof each): ~ (1) <2) 7&w Muck “I game! S’L/Zo/ (3% mag/L /V/"’/€” $ $000 (3) $ c.$ d. Real estate equity ...... /.I./.O.AIE .................... ........................................................................... .. . d.$ e. Other personal property (jewelry, furniture, furs, stocks, bonds, etc.) (list separate/y): MID/WE e.$ Page1of 2 Form Adopted by the Judicial Council of Caiifomia FINANCIAL STATEMENT Code of Civil Procedure. §§ 706.124. 703.530 WWW/EM“Walkman/1.20071 www.courtinfo.m.gov (Wage Garnishment—Enforcement of Judgment) WG-007IEJ-1 65 ' ‘ LEWING OFFICER FILE NO. COURT CASE NO. SHORT TlTLE: =1. The monthly expenses for me, my spouse, and my other dependents a. ‘ 4 a. $ 200 0 ............................................ Rent or house payment and maintenance ..................................... b. Food and household supplies .......... b $ 62g ..................................................................... 0. Utilities and telephone ........ - 0. $ 2 5: 0 .................................................................................. d. ............................................................................ Clothing ......................... -. d. $ 2 Q0 payments e‘. $ .- ..................................................................................................... e. Medical and dental f. etc.) Insurance (life, health, accident, ' I _ f. $ 5m ....................................................................................... $ —- School, child care ................ ....................................................................................................... g . 9. h $ ' - Child, spousal support‘(prior marriage) ...................................................................................... 1a 0 h. carpayments initem 5) ..............$ Transportation & auto expenses (insurance, gas, repair) (list 1 l. ' below in item j. .................................................. $ j. installment payments (insert total and itemize 5) k. $ — k. Laundry and cleaning ...................................................................................................... l $ —- l. Entertainment ............................................................................................................................. m. Other (specify): m. $ 2 r29 n. TOTAL MONTHLY EXPENSES (add a through m): n. $ 3 KW 0 ................................................................ 5. I, my spouse, and my other dependents owe the following debts: OWED BY CREDITOR'S NAME FOR ~ MO. PAYMENTS BALANCE OWED (State person's name) I? u 1‘0 __ Car : 14/90 ’ ”owe - ‘ all; ' Ban K , _ ase 19444” flmaaone 6/0/6041 13:90 {or}: . . .- 61’ ”Wt" fled/9U; )0,» #20694 Zfé’ (317‘3 tuition, expenses for recent family 6. Other facts which support this Claim of Exemption (i.e., unusual medical needs, school expenses emergencies, _or other unusual tohelp yourcreditorand thejudge understand your budget) (describe): (If more space is needed, attach page labeled Attachment 6. ) 7. [ju/e item 1 (specify each person's name and monthly lax/e ' (My, amount): 9/ 5,!ana/ . spouse or dependents named in An earnings withholding order is now in effect with respect to my earnings orthose of my Zy'a. z 0/(;%§ ya spouse or dependents named in 3. [:1 A wage assignment for support is now in effect with respect to my earnings or those of my person's item 1 (specify each name and monthly amount): 3. Ifi [:1 My spouse has signed below. lhave no spouse. ' 1:] /w My spouse and I are living separate and apart. is true and correct. 1declare under penalty of perjury under the laws of the State of California that the foregoing Date: ‘ (Em/QM {lac/Za/flq/L } ; Lie/Z a (TYPEOR PRINTNAME) ('54. amt/ma . . - D ',//6/‘’\..// ' SIGNATl/JBE) z . _ M“ (SIGNATURE OF SPOUSE) (TYPE OR PRINT NAME OF SPOUS Page 2 of 2 NG—007IEJ-165 [Rev. January 1,2007] . FINANCIAL STATEMENT (Wage Garnishment—Enforcement of Judgment) /*\ /“x x \- j t ,4, / .- Response to Request to Make . Clerkstamps here when form is filed. SC'221 . Payments Read both sides of Form SC—220, Request to Make Payments, before you till out this form. I G) I am a judgment creditor in this small claims case. My name is: Mailing address: Phone: Fill in the court name and street address: Superior Court Of California, County 0f ® The judgment debtor who asked to make payments in this case is: , (Name): , > San Mateo 400 County Center Redwood City, CA 94063 ® [I I agree to accept the payment plan in the Request. Fill in your case number and case name: @ I agree to accept a different payment plan (check and complete all that apply): Case Number: a. El Payments of $' A Case Name: on the day of each (month, week, other): Starting (date): , until(dateoffinal payment): amount of final payment: $ b-_El Other payment schedule (Specifil): 0. CI The total amount of payments is $ , which includes interest on the unpaid balance of the judgment. The actual amount of that interest may be different if the payments are made late or early. I Attach a page that shows how you calculated the interest and write “SC-221, Item 4c” at the top. d. [I The total amount of payments is the same as the judgment. Ifall payments are made in full and on time, no interest will be owed on the judgment, and the judgment will be paid in full. 6. C] Other (specijy): Important! If any payment is not made in full and on time, you may notify the court to cancel the payment plan and the entire unpaid balance will become due and collectible. ® I] I do not agree to accept payments because (explain): I] Ifyour answer will not fit " in the space below, check this box and attach your answer on a separate sheet ofpaper. Write “SC-221, Item 5 at the top. 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 '' ' to 'I lie , . r!scaaov .. Response to Request to Make Payments so _221 éi‘lfli'152’,”231§_OSEOElam“ (Small Claims) Code ofCivil Procedure, 5 116.620. Cal. Rules of Court. rule 3.2107