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 CIVIC CENTER DRIVE WEST POST OFFICE BOX 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: NOTICE OF FILING OF PETITION FOR CERTIFICATE OF REHABILITATION AND PARDON (Penal Code § 4852.07) CASE NUMBER: M - To the District Attorney, County of ; County of Petitioner’s Residence To the District Attorney, County of ; County of most recent qualifying conviction, if different from County of Residence To the District Attorney, County of ; County of 2nd most recent qualifying conviction, if applicable To the District Attorney, County of ; County of 3rd most recent qualifying conviction, if applicable On the undersigned has filed a petition in the above mentioned court for a Date of Filing Certificate of Rehabilitation and Pardon in accordance with the provision of

Chapter 3.5, Title 6, Part of the Penal Code of the State of California. The petition will be heard on at in Department at the Superior Court Date of Hearing Time Department of California, County of Orange, Central Justice Center. Date SIGNATURE OF PETITIONER TYPE OR PRINT NAME OF PETITIONER Petitioner’s Address: City, State, ZIP NOTICE OF FILING OF PETITION FOR CERTIFICATE OF REHABILIATION AND PARDON Optional Use Form: L-409 [Rev. December 19, 2024] Pen. Code § 4852.07