SUPERIOR COURT OF CALIFORNIA, COUNTY OF ALAMEDA ο ο ο Fremont Hall of Justice Traffic Division - (510) 818-7502 39439 Paseo Padre Parkway Fremont, CA 94538 ο Gale/Schenone Hall of Justice Traffic Division - (925) 227-6792 5672 Stoneridge Drive Pleasanton, CA 94588 George E. McDonald Hall of Justice Traffic Division - (510) 263-4304 2233 Shoreline Drive Alameda, CA 94501 ο Hayward Hall of Justice Traffic Division - (510) 690-2701 24405 Amador Street Hayward, CA 94544 Wiley W. Manuel Courthouse Traffic Division - (510) 627-4701 661 Washington Street Oakland, CA 94607 CIVIL ASSESSMENT PETITION AND ORDER Defendant’s Request and Declaration to Vacate Civil Assessment on TBDA Case Defendant’s Name: Case Number Citation Number:___________________________ Citation Date:_________________ IMPORTANT: WRITTEN proof of any of the following MUST be attached and cover the time period in question. HOSPITALIZED OVERSEAS MILITARY DUTY INCARCERATED OTHER The following is an explanation of my failure to pay: (Please print) I am providing proof of correction (attached) and requesting reduction of the fine. I declare under penalty of perjury that the foregoing statement is true and correct to the best of my knowledge and that written proof is attached to this form. Executed at on (City and State) (Date) Address: Telephone: Signature: (Defendant) ORDER RE CIVIL ASSESSMENT (COURT USE ONLY) The Court having read and considered the Petition regarding vacating the Civil Assessment pursuant to PC 1214.1(B), hereby makes the following order: Petition to vacate is: Denied Granted Granted on the following conditions: _____________________________________________________________________________________________ Signature: Date: (Presiding Judge) -------------------------------------------------------------------------------To: Defendant Date: Your case has been referred to Alliance One for collection. The amount due on your case is now $______________. Please contact Alliance One within 10 days to make payment in full or to arrange monthly payments. MAILING ADDRESS AllianceOne Receivables Management 8589 Aero Drive San Diego, CA 92123 Telephone: 1-877-541-8420 Online Payments: www.payaoi.com CIVIL ASSESSMENT PETITION AND ORDER Defendant’s Request and Declaration to Vacate Civil Assessment Rev. 7/2/2010 American LegalNet, Inc. www.FormsWorkFlow.com