Petition for Certificate of Rehabilitation and Pardon

Cal. Form L-0408

California Superior Local Rules

L-0408 Petition for Certificate of Rehabilitation and Pardon Penal Code 4852.01 Revised: 12/31/2015 Page 1 of 7 ATTORNEY OR PARTY WITHOUT ATTORNEY (Name & Address): Telephone No.: Fax No. (Optional): E-Mail Address (Optional): ATTORNEY FOR (Name): Bar No: FOR COURT USE ONLY SUPERIOR COURT OF CALIFORNIA, COUNTY OF ORANGE CENTRAL JUSTICE CENTER 700 CIVIC CENTER DRIVE WEST POST OFFICE BOX 22024 SANTA ANA, CA 92702-2024 In the Matter of the Application of Type Petitioner’s full name – First Middle Last and Suffix, if applicable Date of Birth: CII Number: Criminal Case Number(s): PETITION FOR CERTIFICATE OF REHABILITATION AND PARDON (Penal Code 4852.01 et seq.) CASE NUMBER: M - To the Superior Court of California, County of Orange: The above-named petitioner represents and shows that: CONVICTION HISTORY [All qualifying convictions must be listed.

If you have more than three (3) qualifying convictions, attach additional sheets following the same format.] Most Recent Qualifying Conviction (

A) Offense On or about , petitioner was convicted of the crime of Month Day, Year Indicate Crime and Code

Section on case number: in the County of , California. (

B) Type of Sentence or Disposition Petitioner’s sentence for this offense was: [Check the appropriate box] Commitment to state prison or other state institution at ; Name of institution or city where located Sentenced to county jail pursuant to Penal Code 1170(

h) at ; Name of county where located Sentenced to state prison, but execution of sentence was suspended and petitioner was placed on probation. Imposition of sentence was suspended and petitioner was placed on probation.

Name: Case Number: M- L-0408 Petition for Certificate of Rehabilitation and Pardon Penal Code 4852.01 Revised: 12/31/2015 Page 2 of 7 (

C) Date of Release Thereafter, on or about , petitioner was; Date released from custody [Check the appropriate box(es)] Discharged from state prison or other state institution after completing his/her sentence on (date). Released on parole on (date). Released from county jail pursuant to Penal Code 1170(h) (no mandatory supervision) on (date). Released from county jail to serve mandatory supervision pursuant to Penal Code 1170(

h) on (date). Released from custody on probation (after serving a jail sentence as a condition of probation) on (date). Released on probation (if no jail sentence was imposed) on (date). (

D) Penal Code 1203.4 History (For Probationers Only) A. After termination of probation on , a petition for relief under Penal Code

section 1203.4 was granted on (date). B. Has petitioner been incarcerated in any prison, jail, detention facility, or other penal institution or agency after his/her Penal Code

section 1203.4 petition was granted? Yes No C. If yes, when and where? . D. Is petitioner currently on probation or mandatory supervision for the commission of any other felony? Yes No E. Petitioner presents the following evidence that he/she has resided in California for the past five years (supporting documentation may be attached as exhibits to the petition): (

E) Penal Code 1203.41 History (For sentences pursuant to PC 1170(

h) only)

a) A petition for relief under Penal Code

section 1203.41 was granted on __________________(date).

b) Has petitioner been incarcerated in any prison, jail, detention facility, or other penal institution or agency after his/her Penal Code

section 1203.41 petition was granted? Yes _ No_

c) If yes, when and where? _______________________________.

d) Is petitioner currently on probation for the commission of any other felony? Yes_____ No_____

e) Petitioner presents the following evidence that he/she has resided in California for the past five years (supporting documentation may be attached as exhibits to the petition):

Name: Case Number: M- L-0408 Petition for Certificate of Rehabilitation and Pardon Penal Code 4852.01 Revised: 12/31/2015 Page 3 of 7 Second Most Recent Qualifying Conviction (

A) Offense On or about , petitioner was convicted of the crime of Month Day, Year Indicate Crime and Code

Section on case number: in the County of , California. (

B) Type of Sentence or Disposition Petitioner’s sentence for this offense was: [Check the appropriate box] Commitment to state prison or other state institution at ; Name of institution or city where located Sentenced to county jail pursuant to Penal Code 1170(

h) at ; Name of county where located Sentenced to state prison, but execution of sentence was suspended and petitioner was placed on probation. Imposition of sentence was suspended and petitioner was placed on probation. (

C) Date of Release Thereafter, on or about , petitioner was; Date released from custody [Check the appropriate box(es)] Discharged from state prison or other state institution after completing his/her sentence on (date). Released on parole on (date). Released from county jail pursuant to Penal Code 1170(h) (no mandatory supervision) on ________(date; Released from county jail to serve mandatory supervision pursuant to Penal Code 1170(

h) on ________(date; Released from custody on probation (after serving a jail sentence as a condition of probation) on (date). Released on probation (if no jail sentence was imposed) on (date). (

D) Penal Code 1203.4 History (For Probationers Only) A. After termination of probation on _, a petition for relief under Penal Code

section 1203.4 was granted on (date). B. Has petitioner been incarcerated in any prison, jail, detention facility, or other penal institution or agency after his/her Penal Code

section 1203.4 petition was granted? Yes _ No_ C. If yes, when and where? D. Is petitioner currently on probation or mandatory supervision for the commission of any other felony? Yes No E. Petitioner presents the following evidence that he/she has resided in California for the past five years (supporting documentation may be attached as exhibits to the petition):

Name: Case Number: M- L-0408 Petition for Certificate of Rehabilitation and Pardon Penal Code 4852.01 Revised: 12/31/2015 Page 4 of 7 (

E) Penal Code 1203.41 History (For sentences pursuant to PC 1170(

h) only)

a) A petition for relief under Penal Code

section 1203.41 was granted on __________________(date).

b) Has petitioner been incarcerated in any prison, jail, detention facility, or other penal institution or agency after his/her Penal Code

section 1203.41 petition was granted? Yes _ No_

c) If yes, when and where? _______________________________.

d) Is petitioner currently on probation for the commission of any other felony? Yes _____ No_____

e) Petitioner presents the following evidence that he/she has resided in California for the past five years (supporting documentation may be attached as exhibits to the petition): Third Most Recent Qualifying Conviction (

A) Offense On or about , petitioner was convicted of the crime of Month Day, Year Indicate Crime and Code

Section on case number: in the County of , California. (

B) Type of Sentence or Disposition Petitioner’s sentence for this offense was: [Check the appropriate box] Commitment to state prison or other state institution at ; Name of institution or city where located Sentenced to county jail pursuant to Penal Code 1170(

h) at ; Name of county where located Sentenced to state prison, but execution of sentence was suspended and petitioner was placed on probation. Imposition of sentence was suspended and petitioner was placed on probation. (

C) Date of Release Thereafter, on or about , petitioner was; Date released from custody [Check the appropriate box(es)] Discharged from state prison or other state institution after completing his/her sentence on (date). Released on parole on (date). Released from county jail pursuant to Penal Code 1170(h) (no mandatory supervision) on _____________________(date; Released from county jail to serve mandatory supervision pursuant to Penal Code 1170(

h) on ________________(date; Released from custody on probation (after serving a jail sentence as a condition of probation) on _____________(date). Released on probation (if no jail sentence was imposed) on (date).

Name: Case Number: M- L-0408 Petition for Certificate of Rehabilitation and Pardon Penal Code 4852.01 Revised: 12/31/2015 Page 5 of 7 (

D) Penal Code 1203.4 History (For Probationers Only) A. After termination of probation on _, a petition for relief under Penal Code

section 1203.4 was granted on (date). B. Has petitioner been incarcerated in any prison, jail, detention facility, or other penal institution or agency after his/her Penal Code

section 1203.4 petition was granted? Yes ____ No _____ C. If yes, when and where? D. Is petitioner currently on probation or mandatory supervision for the commission of any other felony? Yes ____ No _____ E. Petitioner presents the following evidence that he/she has resided in California for the past five years (supporting documentation may be attached as exhibits to the petition): F. G. H. (

E) Penal Code 1203.41 History (For sentences pursuant to PC 1170(

h) only) A. A petition for relief under Penal Code

section 1203.41 was granted on __________________(date). B. Has petitioner been incarcerated in any prison, jail, detention facility, or other penal institution or agency after his/her Penal Code

section 1203.41 petition was granted? Yes _____ No_____ C. If yes, when and where? _______________________________. D. Is petitioner currently on probation for the commission of any other felony? Yes _____ No_____ E. Petitioner presents the following evidence that he/she has resided in California for the past five years (supporting documentation may be attached as exhibits to the petition): RESIDENCY HISTORY I am now a resident of the State of California, and I have continuously resided in the State of California from _________________ __________________________________, to the present date. I currently reside in the County of at the following address: _____

Name: Case Number: M- L-0408 Petition for Certificate of Rehabilitation and Pardon Penal Code 4852.01 Revised: 12/31/2015 Page 6 of 7

Name: Case Number: M- L-0408 Petition for Certificate of Rehabilitation and Pardon Penal Code 4852.01 Revised: 12/31/2015 Page 7 of 7 PETITIONER’S DECLARATION During the period of my rehabilitation, I have lived an honest and upright life, conducted myself with sobriety and industry, and exhibited good moral character. I have conformed to and obeyed all the laws of the land. I request that the Court make its order declaring that I have been rehabilitated; and for a Certificate of Rehabilitation recommending that the Governor of the State of California grant me a full pardon.

I declare under penalty of perjury under the laws of the State of California that the foregoing information is true and correct. Date SIGNATURE OF PETITIONER TYPE OR PRINT NAME OF PETITIONER

Document details

Collection	California Superior Local Rules
Citation	Cal. Form L-0408
Type	court_rule
Language	en
Format	pdf
Source	CA_LOCAL
Identifier	5327b062227c18c076ae97f8a3328c606e34804d

Source file is stored in the law ingest library (pdf).