RSCC-20A-E (2014/01)

ONTARIO Superior Court of Justice Certificate of Judgment

Form 20A Ont. Reg. No.: 258/98

Seal

Small Claims Court

Address

Phone Number

Claim No.

BETWEEN

Creditor(s)

and

Debtor(s)

A judgment was made in this action on , 20 , in the

(Name of court where judgment was made)

againstLast name of debtor, or name of company

First name Second name Third name

Address

Last name of debtor, or name of company

First name Second name Third name

Address

Last name of debtor, or name of company

First name Second name Third name

Address

Additional debtor(s) and also known as names are listed on attached Form 1A.1.

Les formules des tribunaux sont affichées en anglais et en français sur le site www.ontariocourtforms.on.ca. Visitez ce site pour des renseignements sur des formats accessibles.

RSCC-20A-E (2014/01)

Claim No.FORM 20A PAGE 2

Judgment was made for the following sums:

(A) AMOUNT OF JUDGMENT (debt and pre-judgment interest) $

(B) COSTS to date of judgment $

Post-judgement interest continues to accrue at(Interest rate)

% per annum.

, 20(Signature of clerk)

TO THE CLERK OF THE(Name of court to where the judgment is to be filed)

SMALL CLAIMS COURT:

The person requesting this certificate is(Name of party requesting certificate)

(Address of party requesting certificate)