SC-221

Response to Request to Make 
Payments

Clerk stamps here when form is filed.

Read both sides of Form SC-220, Request to Make Payments, before you fill out 
this form.


I am a judgment creditor in this small claims case.

My name is:
Mailing address: 

Phone: 

The judgment debtor who asked to make payments in this case is: 
(Name):  

I agree to accept the payment plan in the Request. 

Fill in the court name and street address:

Superior Court of California, County of

I agree to accept a different payment plan (check and complete all that apply):

Fill in your case number and case name:
Case Number:

Payments of $                                                                                   , 
on the                    day of each (month, week, other):               
Starting (date):                    , until (date of final payment):                   ;

Case Name:

amount of final payment: $

Other payment schedule (specify): 

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-221, Item 4c” at the top.                 

The total amount of payments is the same as the judgment. If all payments are made in full and on time, no 
interest will be owed on the judgment, and the judgment will be paid in full.   

Other (specify): 

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 do not agree to accept payments because (explain):
     If your answer will not fit in the space below, check this box and attach your answer on a separate sheet of paper. 
      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. 

Type or print your name                                                                                   Sign here

Judicial Council of California, www.courts.ca.gov
Rev. July 1, 2013, Optional Form
Code of Civil Procedure, § 116.620, Cal. Rules of Court, rule 3.2107

     Response to Request to Make Payments  
(Small Claims)

SC-221







a.

b.

c.

d.

e.

ate:   

 D