CERTIFICATE OF REHABILIATION Optional Use Penal Code2474852.13 SUPERIOR COURT OF CALIFORNIA, COUNTY OF For Court Use Only In the Matter of the Application ofPetitioner222s full name 226First Middle Last and Suffix, if applicable Date of Birth: CII Number: Criminal Case Number(s): CERTIFICATE OF REHABILITATION (Penal Code 2474852.13) CERTIFICATE NUMBER: The petition of, presently residingType Applicant222s Full Name -First Middle Last and Suffix, if applicable at,requesting a Type Applicant's Street Address, City, State, and ZIP Code a Certificate of Rehabilitation pursuant to the provisions of Chapter 3.5, Title 6 of Part 3 of the Penal Codeof the State of California, was heardonDate and proof having been made to the satisfaction of the Court that noticeof the time of hearing has been regularly given as required by law; and from satisfactory proof taken at said hearing the Court finds that all allegations of said petition are true, and that the required period of rehabilitation has elapsed since petitioner's date of discharge from custody due to completion of the term to which the petitioner was sentenced, or upon the release on parole or probation on , that, where appropriate, petitioner hasobtained relief pursuant to Penal Month Day, Year Penal Code section 1203.4, and that petitioner has demonstrated by the course of conduct his/her rehabilitation and fitness to exercise all the civil and political rights of citizenship(except as provided in Penal Code section 4852.15); and that the that petitioner has beentime(s) convicted of a felony;Total Number of Felony Convictions The Certificate of Rehabilitation is granted. This Court declaresthe petitioner has been rehabilitated and is fit to exercise all the civil and political rights of citizenship (except as provided in Penal Code section 4852.15), and this Court recommends that the Governor of the State of California grant a full pardon to said petitioner.Dated:Judicial Officer-TYPED or PRINTEDJudicial Officer-SIGNATURE This form was prepared under the direction of the Office of the Attorney General of the State of California American LegalNet, Inc. www.FormsWorkFlow.com