Affidavit Pursuant To CCA 1811 (d) Upon Payment Of Judgement {CIV-SC-93}

CIVIL COURT OF THE CITY OF NEW YORK SMALL AND COMMERCIAL CLAIMS PART Index No. Claimant(s)/Plaintiff(s) - against - AFFIDAVIT PURSUANT TO CCA § 1811 (d) UPON PAYMENT OF JUDGMENT Defendant(s)/Respondent(s) State of New York, County of ss: , being duly sworn, deposes and says: (Name of Deponent) I am the Judgment Debtor in the above captioned case. In accordance with the requirements set forth in § 1811(d) of the Civil Court Act, I present proof to the court that I have satisfied the Judgment and request that the court indicate such in the records. Submitted please find: G Copy(ies) of canceled check(s) G Copy(ies) of signed receipt(s) G Copies of money order or tracer(s) G Other (specify) Date Sworn to me this day of , 20 . Judgment Debtor Signature of Notary Public or Court Clerk CIV-SC-93 (Revised, September, 2006) American LegalNet, Inc. www.FormsWorkFlow.com