File this form at: Amador Superior Court, 500 Argonaut Lane, Jackson, CA 95642 [NAME, ADDRESS & PHONE # OF PARTY MAKING THE REQUEST] PLAINTIFF: FOR COURT USE ONLY PEOPLE OF THE STATE OF CALIFORNIA Vs DEFENDANT: REQUEST FOR MODIFICATION OF: HEARING DATE: PROBATION FINE DUE DATE CASE NUMBER: , am the defendant in this case and am seeking to modify my: I, [YOUR NAME] PROBATION FINE DUE DATE (A $30.00 collection fee will be imposed). Defendant’s Statement of Assets (CR-115), must be attached. due to [EXPLAIN WHY THE MODIFICATION IS NEEDED AND IF NECESSARY THE TIME REQUIRED] I can pay the fine by [PROVIDE A REALISTIC DATE BY WHICH YOU CAN PAY THE FINE] I request the court order work program in lieu of fine. I understand the court may set this request for hearing, my available dates are: _________________________________________ I declare under penalty of perjury under the laws of the State of California the above information is true and correct. DATED: [SIGNATURE OF DEFENDANT] [BE SURE TO COMPLETE PAGE 2 OF THE FORM] [TO BE COMPLETED BY JUDGE] Defendant’s request is set for hearing on: AT Defendant’s request is denied. Defendant’s request is granted. ⌧ In Whole In part A $30.00 collection fee is imposed for all requests to extend fine due date. DATED: JUDGE OF THE SUPERIOR COURT 01/11 REQUEST FOR MODIFICATION CRIM025 American LegalNet, Inc. www.FormsWorkFlow.com 1 PROOF OF SERVICE BY MAIL H. SWIFT, Clerk of the Amador Superior Court, State of California, and not a party to the within entitled action, served the attached. REQUEST FOR MODIFICATION on the parties in said action, by placing a true copy thereof enclosed in a sealed envelope with postage thereon addressed as shown, for collection and mailing pursuant to the ordinary business practice of the office which is that mail is collected and deposited with the United States Postal Service on the same day in the ordinary course of business. AMADOR COUNTY OFFICE OF THE DISTRICT ATTORNEY 708 COURT STREET JACKSON, CA 95642 COUNSEL FOR PEOPLE AMADOR COUNTY PROBATION DEPARTMENT 675 NEW YORK RANCH ROAD JACKSON, CA 95642 (VIA INTER OFFICE MAIL) ____________________________________________ DEFENDANT (VIA INTER OFFICE MAIL) [YOUR NAME] ____________________________________________ [YOUR MAILING ADDRESS] ____________________________________________ [YOUR MAILING ADDRESS] ____________________________________________ [YOUR PHONE NUMBER] [TO BE COMPLETED BY CLERK] I declare under penalty of perjury under the laws of the State of California that the foregoing is true and correct. . Executed at Jackson, California on H. SWIFT, CLERK By ________________________________ Deputy Clerk 01/11 REQUEST FOR MODIFICATION CRIM025 American LegalNet, Inc. www.FormsWorkFlow.com 2