Superior Court of California, County of Amador Collection Unit 500 Argonaut Lane Jackson, CA 95642 (209) 257-2688 Request to Vacate Civil Assessment (PC 1214.1) Information and Instruction Sheet What is Civil Assessment? A Civil Assessment fee of $300 is imposed against anyone who does not appear (FTA) in court and/or pay a court-ordered fine by the due date (FTP). The Civil Assessment is addition to any fine and fees associated to your case. You must pay the Civil Assessment even if you are not found guilty of the traffic citation. Can the Civil Assessment be Reviewed? You may ask the Court to remove the Civil Assessment for one of the following reasons: Hospitalization Incarceration Military Duty Death Housed in Residential Treatment Extenuating Circumstance What Do I Do? 1. Fill out the "Request to Vacate Civil Assessment" form. 2. Provide a written explanation of the reason you did not appear or contact the court by the date specified on your citation. Attach supporting documentation with your petition. Your petition may be denied if written proof is not received. Examples of supporting documentation include: Records of admission and discharge from the hospital (the court does not need to know your medical condition) Court orders to remand into custody/or records of release from custody Appropriate military orders for active service Death certificate American LegalNet, Inc. www.FormsWorkFlow.com APPROVED FOR OPTIONAL USE AMADOR SUPERIOR COURT REQUEST TO VACATE CIVIL ASSESSMENT (REV. 11/29/16) - TRF-235 Superior Court of California, County of Amador Collection Unit 500 Argonaut Lane Jackson, CA 95642 (209) 257-2688 Request to Vacate Civil Assessment (PC 1214.1) Petition and Order Defendant's Name Case Number IMPORTANT: Provide a written explanation of any of the following that shows you were unable to appear or contact the court. Attach supporting documentation with your petition. Your petition may be denied if written proof or supporting documentation is not received. HOSPITALIZED INCARCERATED MILITARY DUTY DEATH RESIDENTIAL TREATMENT EXTENUATING CIRCUMSTANCE The following is an explanation of my failure to appear and/or pay: (Please print and include attachments) I declare under penalty of perjury that the foregoing statement is true and correct to the best of my knowledge. Executed at City and State on Date Mailing Address Telephone # Signature ORDER RE: CIVIL ASSESSMENT (COURT USE ONLY) Assessed Amount $ The Court having read and considered the Petition regarding vacating the Civil Assessment pursuant to PC 1214.1, hereby makes the following order: Defendant's Petition to Vacate is: GRANTED DENIED GRANTED IN PART. Civil Assessment Reduced to $ BALANCE OF $___________ DUE FORTHWITH, OR CONTACT COLLECTIONS FOR PAYMENT PLAN (1-866-378-8758) Signature Judicial Officer APPROVED FOR OPTIONAL USE AMADOR SUPERIOR COURT REQUEST TO VACATE CIVIL ASSESSMENT (REV. 11/29/16) - TRF-235 Date American LegalNet, Inc. www.FormsWorkFlow.com