COURT COUNTY .OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ......... .. : SUPERIOR COURT OF CALIFORNIA, COUNTY OF STREET ADDRESS: MAILING ADDRESS: CITY AND ZIP CODE: BRANCH NAME: Index No. CR-151 : Plaintiff(s) : : : : Calendar No. FOR COURT USE ONLY JUDICIAL SUBPOENA -against- PEOPLE OF THE STATE OF CALIFORNIA v. DEFENDANT: Defendant(s) : ...................................................... PETITION FOR CERTIFICATE OF IDENTITY THEFT (PEN. CODE, § 530.6) CASE NUMBER: THE PEOPLE OF THE STATE OF NEW YORK 1. a. Your name (person asking for the certificate): TO Your address GREETINGS: (if you want your address to be private, give a mailing address instead): WE COMMAND YOU, that all business and excuses being laid aside, you and each of you attend before , theCity: Honorable at the Court Zip Code: State: located at County of in room , on the day of , 20 , at o'clock in the noon, and at any recessed Your telephone number (optional): or adjourned date, to testify and give evidence as a witness in this action on the part of the b. Your lawyer, if you have one (specify name, address, telephone number, and State Bar number below): Your failure to comply with this subpoena is punishable as a contempt of court and will make you liable to theAddress: whose behalf this subpoena was issued for a maximum penalty of $50 and all damages sustained as a party on result of your failure to comply. Telephone number: State Bar number:Honorable Witness, Name: , one of the Justices of the day of , 20 Court in 2. County, I have been the victim of the crime of identity theft. (If available, attach a copy of the report of the suspected crime of identity theft, issued by the local law enforcement agency that has jurisdiction over your actual residence. Mark the report as Attachment 2.) (Attorney must sign above and type name below) I need a Certificate of Identity Theft: Judicial Finding of Factual Innocence, because (check applicable boxes and fill in applicable blanks): a. (1) (2) 3. Attorney(s) for An identity thief was cited in my name. (Attach a copy of the citation, if available. Mark it as Attachment 3a.) Date of citation: Violation of law stated in citation: (3) (4) Citation number: Agency that issued the citation: Office and P.O. Address Telephone No.: This is not a Court Order. Form Approved for Optional Use Judicial Council of California CR-151 [New January 1, 2005] Facsimile No.: E-Mail Address: PETITION FOR CERTIFICATE OF IDENTITY THEFT (PEN. CODE, § 530.6) Mobile Tel. No.: Page 1 of 3 Penal Code, § 530.6 www.courtinfo.ca.gov American LegalNet, Inc. www.USCourtForms.com PEOPLE OF THE STATE OF CALIFORNIA v. DEFENDANT: CASE NUMBER: b. (1) (2) An identity thief was arrested in my name. (Attach a copy of the warrant, if available. Mark it as Attachment 3b.) Date of arrest: Arrest warrant number: (3) (4) Arresting agency: Agency that issued the warrant: c. An identity thief was convicted of a crime in my name. (Attach a copy of the judgment of conviction, if available. Mark it as Attachment 3c.) (1) (2) Date of conviction: Crime: (3) (4) Name of court: Case number: d. (1) (2) e. (1) (2) f. A criminal complaint has been filed against an identity thief in my name. (Attach a copy of the criminal complaint, if available. Mark it as Attachment 3d.) Name of court: Case number: My identity has been mistakenly associated with a record of criminal conviction. Date of conviction: Case involved (describe subject matter of case): I was arrested for a crime committed by an identity thief using my name. (Attach a copy of the arrest warrant, if available. Mark it as Attachment 3f.) (1) (2) (3) (4) (5) (6) Date of arrest: Arrest warrant number: Agency that issued the warrant: Arresting agency: Date I submitted my petition to the arresting agency under Penal Code section 851.8: Date the arresting agency denied that petition: (Attach copy of the petition, if available. Mark it as Attachment 3f). 4. There is no reasonable cause to believe that I committed the offense for which the identity thief was arrested, cited, convicted, or was the actual subject of a criminal complaint in my name; or there is reasonable cause to believe that my identity has been mistakenly associated with a record of criminal conviction. This is not a Court Order. CR-151 [New January 1, 2005] PETITION FOR CERTIFICATE OF IDENTITY THEFT (PEN. CODE, § 530.6) Page 2 of 3 PEOPLE OF THE STATE OF CALIFORNIA v. DEFENDANT: CASE NUMBER: 5. I will provide to the judge my basic personal identification information, such as my full name, date of birth, gender, weight, height, natural hair color, natural eye color, race, age, driver's license or identification number, and fingerprints (if required by the court); however, such information is not included in this petition in order to avoid further publishing the information. The following additional facts and/or designated exhibits support this petition: 6. Continued on Attachment 6. 7. I understand that the court may vacate the certificate of identity theft at any time if this petition, or any part of the information submitted in support of this petition, is found to contain any material misrepresentations or fraud. Number of pages attached: 8. I declare under penalty of perjury under the laws of the state of California that the foregoing is true and correct. Date: Sign your name Print your name This is not a Court Order. CR-151 [New January 1, 2005] PETITION FOR CERTIFICATE OF IDENTITY THEFT (PEN. CODE, § 530.6) Page 3 of 3