_______________________, pro se
Name
____________________________________________
Address
_____________________________________
Telephone
IN THE _________ JUDICIAL DISTRICT COURT
________________ COUNTY, STATE OF ___________________
__________________________ STIPULATION
Petitioner
vs
______________________________________________ Case No. _____________ _
Defendant(s) Judge: _________________
On ___________________, 2019
_________________ (Plaintiff) and ___________________________________ (defendants) have entered into the following agreement:
- The defendants agree to pay $_____.
- The defendants agree to pay $_____ on ______________, 19 (Monday), and $______ on ____________________, 19 (Monday), and $_____ on __________________, 19.
- The defendants agree to pay $____________ for the ____________ rent on ______ 5th, 19.
- The case #____________ is not voided when this stipulation is executed.
- Defendants need to file proof of payments in the court within two (2) business days after each payment.
- If the terms (a, b, c, e) of this stipulation are not met in full, Plaintiff can request an Order of Restitution signed without an Occupancy Hearing.
Signing this form indicated that both parties accept the terms of this agreement.
Plaintiff(s) Defendant(s)
Date _____________________