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1 Any Attorney or Party

Any Street
2 Any Town, CA 55555

3 714-555-5555

4 Any Attorney or Party

8 Superior Court of the State of California

9 For the County of _________________

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11 In re the matter of the Confession of Judgment by ) Case No.


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12 ____________________, ) VERIFIED STATEMENT OF DEFENDANT
Defendant, ) CONFESSING JUDGMENT
13 )
In Favor of )
14 )
_______________________, )
15 Plaintiff. )
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I, LIST FULL NAME OF DEFENDANT CONFESSING JUDGMENT, hereby confess
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judgment in the above-entitled cause in favor of Plaintiff, LIST FULL NAME OF PLAINTIFF, in
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the sum of $_______ and authorize entry of judgment against me for that sum.

7 EITHER, if judgment is for debt due or to become due:

8 This confession of judgment is for a debt ___________________ justly due or to become due,
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arising out of the following factual situation: DESCRIBE IN DETAIL THE FACTS THAT GIVE
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RISE TO THE OBLIGATION,
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OR, if judgment will secure contingent liability:
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13 This confession of judgment is for the purpose of securing a contingent liability that arises out

14 of the following facts: DESCRIBE IN DETAIL THE FACTS THAT GIVE RISE TO THE
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CONTINGENT LIABILITY AND THAT SHOW THAT THE SUM CONFESSESD DOES
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NOT EXCEED THE CONTINGENT LIABILITY.
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Dated:___________________ _____________________________________________
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FULL NAME OF DEFENDANT
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