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    LACIV215

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    johnathan fissella
    This document requests entry of judgment in a labor code case. It provides details of the requested judgment including principal, attorney fees, costs, and interest. It also contains sections for the judgment, notice of entry, and certificate of mailing.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd

    LACIV215

    Uploaded by

    johnathan fissella
    17 views2 pages
    This document requests entry of judgment in a labor code case. It provides details of the requested judgment including principal, attorney fees, costs, and interest. It also contains sections for the judgment, notice of entry, and certificate of mailing.

    Copyright

    © © All Rights Reserved

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    PDF, TXT or read online from Scribd

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    This document requests entry of judgment in a labor code case. It provides details of the requested judgment including principal, attorney fees, costs, and interest. It also contains sections for the judgment, notice of entry, and certificate of mailing.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    17 views2 pages

    LACIV215

    Uploaded by

    johnathan fissella
    This document requests entry of judgment in a labor code case. It provides details of the requested judgment including principal, attorney fees, costs, and interest. It also contains sections for the judgment, notice of entry, and certificate of mailing.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    of 2

    NAME, ADDRESS, AND TELEPHONE NUMBER OF ATTORNEY OR PARTY WITHOUT ATTORNEY: STATE BAR NUMBER Reserved for Clerk’s

    or Clerk’s File Stamp

    To prevent others from


    viewing what you have
    ATTORNEY FOR (Name):
    entered on your form,
    SUPERIOR COURT OF CALIFORNIA, COUNTY OF LOS ANGELES please press the Clear
    COURTHOUSE ADDRESS:
    This Form button at the
    PLAINTIFF/PETITIONER: end of this form when
    finished.
    DEFENDANT/RESPONDENT:

    CASE NUMBER:

    REQUEST FOR ENTRY OF JUDGMENT, JUDGMENT,


    AND NOTICE OF ENTRY OF JUDGMENT –
    LABOR CODE SECTION 5806
    AND ISSUANCE OF A WRIT OF EXECUTION
    AND/OR OTHER ENFORCEMENT

    REQUEST FOR ENTRY OF JUDGMENT

    The Clerk of the Court is requested to enter judgment in favor of:


    Plaintiff(s) Defendant(s)

    Against Plaintiff(s) Defendant(s) , pursuant to the


    Labor Code section 5806 as follows:

    a. Principal…….………………………………………………………………… $
    b. Attorney Fees………………………………………………………………… $
    c. Costs (including civil filing fee and administrative charge)……………… $
    d. Amount of judgment requested ………………..……………………………$
    e. Prejudgment interest of the annual rate for % ……………$
    f. Total judgment requested ………………………………………………….. $
    g. Plus interest after judgment at the legal rate.

    A certified copy of the Order Approving Compromise & Release form of the Division of Workers Compensation is
    attached.

    I declare under penalty of perjury under the laws of the State of California that the foregoing is true and correct.

    Dated: By:

    Attorney for

    LASC LACIV 215 Rev. 01/23 REQUEST FOR ENTRY OF JUDGMENT, JUDGMENT, Labor Code,§ § 5806, 5811
    For Optional Use AND NOTICE OF ENTRY OF JUDGMENT -
    LABOR CODE SECTION 5806 Page 1 of 2
    PLAINTIFF/PETITIONER (Name): CASE NUMBER

    DEFENDANT/RESPONDENT (Name):

    JUDGMENT AND NOTICE OF ENTRY OF JUDGMENT

    Judgment entered in favor of:


    Plaintiff(s) Defendant(s)

    Against Plaintiff(s) Defendant(s)

    a. Principal…….………………………………………………………………… $
    b. Attorney Fees………………………………………………………………… $
    c. Costs granted by the Appeals Board . . . . . . . . . ………...……………… $
    d. Amount of judgment requested ………………..……………………………$
    e. Prejudgment interest of the annual rate for % ……………$
    f. Total judgment requested ………………………………………………….. $
    g. Plus interest after judgment at the legal rate.

    Judgment entered on .

    Dated: DAVID W. SLAYTON, Executive Officer/Clerk of Court

    By:
    Deputy Clerk

    CERTIFICATE OF MAILING

    I, the below-named Executive Officer/Clerk of Court of the above-entitled court, do hereby certify that I am not a party to
    the cause herein, and that on this date I served the Request for Entry of Judgment, Judgment, and Notice of Entry
    of Judgment – Labor Code section 5806 upon each party or counsel named below by depositing in the United States
    mail at the courthouse in , California, one copy of the original filed/entered herein in a
    separate sealed envelope to each address as shown below with postage thereon fully prepaid.

    DAVID W. SLAYTON, Executive Officer/Clerk of Court

    By:
    Deputy Clerk
    Print This Form Clear This Form
    LASC LACIV 215 Rev. 01/23 REQUEST FOR ENTRY OF JUDGMENT, JUDGMENT, Labor Code,§ § 5806, 5811
    For Optional Use AND NOTICE OF ENTRY OF JUDGMENT -
    LABOR CODE SECTION 5806 Page 2 of 2

    To protect your privacy, please press the Clear This Form button, when you have finished printing this form.

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