SUPERIOR COURT OF THE STATE OF CALIFORNIA FOR THE COUNTY OF DEL NORTE THE PEOPLE OF THE STATE OF CALIFORNIA, Plaintiff, vs. . Defendant. ) ) ) ) ) ) ) ) ) ) EX PARTE REQUEST & ORDER RE: FINE PAYMENTS/COMMUNITY WORK SERVICE CASE NO.: I am currently ordered: per month to begin To make fine payments of $ To pay fine amount of $ in full on or before hours per month. To do community work service of at least I hereby request: My fines be converted to community work service. I am able, and agree, to complete at least hours per month. If this request is granted I understand that within 7 days I must report to the community work service office located at the Probation Department, 450 H Street, Room 202, Crescent City, CA 95531 between the hours of 8:00 a.m.-5:00 p.m. to sign up for the program. I understand I cannot work off the portion of my fine attributable to Penal Code §1202.4 (restitution) or Penal Code §1465.8 [eff. 8-17-03] ($30 surcharge) and agree I will pay that portion if I have not already done so. I can pay $ per month. My community work service be converted to fines. I am able to pay at least $ per month no later than the 10th (other day): of each month, beginning the calendar month after this request is filed, Other: My fines/community work service be suspended for the following months: Request is made for the following reason(s): Fines in this case be consolidated with the following cases: with a total monthly payment of $ To serve out my fines in jail. I understand that if this request is granted and I am on probation that my probation terms will be amended to require conformance with the granted request. I consent to such an order and amendment of my probation terms. Dated: Defendant's Signature Street Address City, State, Zip Code Form Adopted for Mandatory Use DN-101 (Rev. January 1, 2012) EX PARTE REQUEST & ORDER RE: FINE PAYMENTS/COMMUNITY WORK SERVICE SUPERIOR COURT OF CALIFORNIA COUNTY OF DEL NORTE Page 1 of 2 American LegalNet, Inc. www.FormsWorkFlow.com For Clerk Use: Defendant is on not on probation. Expires: Current fine balance $ Payment history is attached. Warrant is currently outstanding for nonpayment/failure to do community work service. OSC for fine/CWS is set for the following date: Defendant owes does not owe P.C. 1465.8 ($30.00) This is first second third or more requests for conversion of the fine/CWS. Clerks Initials: ORDER Request is granted as made. Defendant is ordered to comply and if on probation, probation terms are so amended. §1202.4 fine and §1465.8 surcharge is to be paid at the rate of $ per month beginning: Request is denied. Reason: Request will be heard at (time): a.m. p.m. on (day): (date): . Defendant is ordered to be personally present or arrange for counsel to be present. Comment: Request is granted as modified: Warrant is recalled. OSC mentioned above is hereby vacated. Defendant need not appear. Other: DATED: Judge of the Superior Court CC: District Attorney Defense Counsel Defendant Community Work Service EX PARTE REQUEST & ORDER RE: FINE PAYMENTS/COMMUNITY WORK SERVICE SUPERIOR COURT OF CALIFORNIA COUNTY OF DEL NORTE Page 2 of 2 American LegalNet, Inc. www.FormsWorkFlow.com Form Adopted for Mandatory Use DN-101 (Rev. January 1, 2012)