Superior Court of California, County of Contra Costa AUTHORIZATION FOR INVESTIGATION OF SECTION 1203.4 P.C., 1203.4(a)/1203.4a(a) P.C. I do hereby authorize Contra Costa County Probation Department, State of California, for me and in my name to apply for the relief indicated below to the Superior Court of the State of California, in and for the County of Contra Costa. To withdraw my plea of guilty or set aside the verdict of guilty duly entered herein and to dismiss the accusation or information against me pursuant to Section 1203.4 of the Penal Code of California. I understand that this Application and Investigation will require a criminal record inquiry, which I hereby authorize. Furthermore, I understand that the law provides for a service fee of up to $150 for the processing of a 1203.4 P.C. Application. Name at time of conviction: _____________________________________________________ Current name: _______________________________________________________________ Aliases:____________________________ D.O.B: / _____________________________________ / I successfully completed probation including payment of all restitution fines and fees. I am not on probation or parole in any jurisdiction. I do not have any pending criminal cases in any jurisdiction. I have submitted documentation supporting my inability to pay restitution fines and fees due to low or no income. Docket #(s): ____________________________________ Current Address: _______________________________________ _______________________________________ Current Phone: __________________________________ Signature: ______________________________________ Date Signed:____________________________________ Local Court Form CR-503 New 11/1/10 American LegalNet, Inc. www.FormsWorkFlow.com