SUPERIOR COURT OF CALIFORNIA, COUNTY OF ALAMEDA Fremont Hall of Justice Traffic Division 39439 Paseo Padre Parkway Fremont, CA 94538 Wiley W. Manuel Courthouse Traffic Division 661 Washington Street Oakland, CA 94607 APPLICATION TO VACATE CIVIL ASSESSMENT Defendant's Name Mailing Address City, State, Zip Phone Case Number Failure to Appear Date Citation Date DECLARATION OF DEFENDANT The reason(s) checked below constitute good cause for my failure to appear and support(s) my request to vacate the civil assessment: (You must complete this section and you must attach written proof that the reason(s) existed on the appearance due date.) Hospitalization Out-of-state military duty Incarceration Not Person Cited Other (explain):_________________________________________________________________________________ ________________________________________________________________________________________________ ________________________________________________________________________________________________ ________________________________________________________________________________________________ I declare under penalty of perjury under the laws of the State of California that the statements above are true and correct to the best of my knowledge and that written proof is attached to this form. Executed on (Date) at (City and State) ___ Signed: ________________________________________________ ORDER (COURT USE ONLY) The Court, having read and considered the foregoing, orders the Application to Vacate: Denied Reason for denial (optional): ____________________________________________ ____________________________________________________________________ ____________________________________________________________________ Your case has been referred to Alliance One for collection. Please contact Alliance One within 10 days to make payment in full or to arrange monthly payments. MAILING ADDRESS Alliance One Receivables Management 8589 Aero Drive, San Diego, CA 92123 Granted Date: Judge or Commissioner of the Superior Court APPLICATION AND ORDER TO VACATE CIVIL ASSESSMENT (rev. 7.24.12) American LegalNet, Inc. www.FormsWorkFlow.com Telephone: 1-877-541-8420 Online Payments: www.payaoi.com