ACKNOWLEDGMENT OF
SATISFACTION OF JUDGMENT
IN COUNTERCLAIM

DOCKET NUMBER 

Trial Court of Massachusetts
District Court Department

DEFENDANT(S) FILING THIS FORM 

COURT DIVISION

PLAINTIFF(S)

DATE THIS JUDGMENT WAS ENTERED

VS.

I (we) hereby certify under the pains of perjury that:

G I am (we are) the defendant(s) who prevailed in a counterclaim

against the above-listed plaintiff(s) in the above-listed small claim or civil action,

G I am (we are) attorney(s) for the defendant(s) who prevailed in a counterclaim 
against the above-listed plaintiff(s) in the above-listed small claim or civil action,

and that the judgment entered by this Court in that counterclaim on the above-listed date 
for the defendant(s) and against the plaintiff(s) has been FULLY SATISFIED.

X                                                                                                                 
DEFENDANT

__________________
DATE

                                                                                                                    
PRINT NAME

X                                                                                                                
ADDITIONAL DEFENDANT

__________________
DATE

                                                                                                                    
PRINT NAME

X                                                                                                                
ADDITIONAL DEFENDANT

                                    
DATE

                                                                                                                    
PRINT NAME

X                                                                                                                
ADDITIONAL DEFENDANT

__________________
DATE

                                                                                                                    
PRINT NAME

OR

X                                                                                                                
ATTORNEY FOR DEFENDANT(S)

                                    
DATE

_____________________________
BBO No.

X                                                                                                                
ATTORNEY FOR DEFENDANT(S)

__________________
DATE

                                                           
BBO No.

 (10/09)       www.mass.gov/courts/districtcourt