Superior Court of California, County of Contra Costa MARTINEZ PITTSBURG RICHMOND WALNUT CREEK Case Number: ____________________________ PETITION RE: CHANGE OF PLEA AND DISMISSAL UNDER PENAL CODE SECTION 1203.4/1203.4a PETITION I, ___________________________, the defendant in the above-entitled action, was convicted on __________ of a Name Date misdemeanor offense(s) in violation of Penal Code Section(s) __________________________________________ . Check applicable box: Probation was granted; the defendant has fulfilled the conditions of probation for the entire period thereof or has been discharged from probation prior to the termination of the period hereof. No probation was granted; more than one year has elapsed since the date of pronouncement of judgment and the sentence of the court has been complied with. The defendant is not serving a sentence for any offense, nor is he charged with the commission of any crime, and since pronouncement of judgment has lived an honest and upright life and obeyed the laws of the land. Petitioner requests that defendant be permitted to withdraw his plea of guilty or plea of nolo contendere or that the verdict or finding of guilt be set aside and that a plea of not guilty be entered and that the court dismiss this action pursuant to provisions of Section 1203.4/1203.4a of the Penal Code. I declare under penalty of perjury that the foregoing is true and correct. Executed on ______________________ at ________________________________________________, California. Date Place _______________________________________________ Signature of Petitioner Petition set for hearing on _______________ at _____________________________________ in Department __________________. Date Court Location PETITION UNDER PENAL CODE 1203.4/1203.4(a) Local Court Form CR-501 New 11/1/10 American LegalNet, Inc. www.FormsWorkFlow.com