REQUEST FOR MODIFICATION-(Rev 10/05/2018)-CRIM025 I, , am the defendant in this case and am seeking to modify my: [YOUR NAME] 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. DATED: [SIGNATURE OF DEFENDANT] [TO BE COMPLETED BY JUDGE] AT In Whole In part A $30.00 collection fee is imposed pursuant to PC2471205(e). A $30.00 collection fee was previously imposed Defendant is ordered to report to the Collections Department forthwith. DATED: JUDGE OF THE SUPERIOR COURT FOR COURT USE ONLY PLAINTIFF: PEOPLE OF THE STATE OF CALIFORNIA Vs DEFENDANT: REQUES T FOR MODIFICATION OF: HEARING DATE: CASE NUMBER: [NAME, ADDRESS & PHONE # OF PARTY MAKING THE REQUEST] American LegalNet, Inc. www.FormsWorkFlow.com REQUEST FOR MODIFICATION-(Rev 10/05/2018)-CRIM025 PROOF OF SERVICE BY MAIL ROB KLOTZ, 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 (VIA INTER OFFICE MAIL) AMADOR COUNTY PROBATION DEPARTMENT 675 NEW YORK RANCH ROAD JACKSON, CA 95642 (VIA INTER OFFICE MAI L) [YOUR NAME] [YOUR MAILING ADDRESS] [YOUR MAILING ADDRESS] [YOUR PHO NE NUMBER] DEFENDANT [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 . ROB KLOTZ, CLERK By Deputy Clerk American LegalNet, Inc. www.FormsWorkFlow.com