ATTORNEY OR PARTY WITHOUT ATTORNEY (Name, state bar number, and address): TELEPHONE NO. (Optional: FOR COURT USE ONLY FAX NO. (Optional): ATTORNEY FOR (Name): Fresno 1100 Van Ness Ave Fresno, CA 93724 Fowler 127 E. Merced St. Fowler, CA 93625 Civil Clovis 2317 Tuolumne St. Fresno, CA 93721 Kingsburg 1600 California St. Kingsburg, CA 93631 Coalinga 1011 Fifth St. Clovis, CA 93612 160 W. Elm St. Coalinga, CA 93210 Reedley Firebaugh 1325 “O” St. Firebaugh, CA 93622 Sanger 815 “G” St. Reedley, CA 93654 619 “N” St. Sanger, CA 93657 Selma 2424 McCall Ave. Selma, CA 93662 DEFENDANT: CASE NUMBER: APPLICATION AND ORDER TO VACATE CIVIL ASSESSMENT DATE OF FAILURE TO APPEAR: DATE OF FAILURE TO PAY: Defendant requests that the civil assessment in this action be vacated. Defendant asserts that the reason(s) set out below constitute good cause and supports vacating the civil assessment: (you must complete this section and you must attach written proof that the selected item existed on the due date above) Hospitalization Incarceration Out of state military duty Other (explain) I declare under penalty of perjury under the laws of the State of California that the forgoing is true and correct. Executed on: at , (Date) (City and State) (SIGNATURE) (TYPE OR PRINT NAME) (City) (Address of Defendant) (State) (Zip Code) ORDER The application to vacate the civil assessment is: Denied. Your case has been referred to GC Services for collection. Call 1-800-333-8395 to make payment arrangements. Reason for Denial (Optional): Granted. Date: Judge of the Superior Court FTR-25 E05-09 APPLICATION AND ORDER TO VACATE CIVIL ASSESSMENT American LegalNet, Inc. www.FormsWorkflow.com Application to Show Good Cause to Vacate Civil Assessment Checklist Clovis Division 1011 Fifth Street Clovis, CA 93612 Coalinga Division 160 W. Elm Street Coalinga, CA 93210 Firebaugh Division 1325 “O” Street Firebaugh, CA 93622 Fowler Division 127 E. Merced Street Fowler, CA 93625 Fresno Central Division 1100 Van Ness Avenue Fresno, CA 93724 Kingsburg Division 1600 California Street Kingsburg, CA 93631 Reedley Division 815 “G” Street Reedley, CA 93654 Sanger Division 619 “N” Street Sanger, CA 93657 Selma Division 2424 McCall Selma, CA 93662 If you FAILED TO APPEAR and are requesting the Civil Assessment be vacated you must: Complete Good Cause Application Attach Supporting Documentation Attach, if applicable, proof that violations have been corrected Complete Trial By Declaration- JC Form TR-205 (only if contesting original violation) Pay Original Bail Amount If you FAILED TO PAY and are requesting the Civil Assessment be vacated you must: Complete Good Cause Application Attach Supporting Documentation Pay “Past Due” Fine Amount Complete your To-Do-List, by filing or mailing to any Clerk’s Office in Fresno County. American LegalNet, Inc. www.FormsWorkflow.com Fresno County Superior Court Application and Declaration to Vacate Civil Assessment (PC 1214.1) Helpful Information and Instruction Sheet What is Civil Assessment? A Civil Assessment of $300 is imposed against anyone who fails to appear or pay a courtordered fine by the due date. The Civil Assessment is imposed in addition to, and is separate from, any fine and fees connected with your case. You are required to pay the Civil Assessment even if you contest your traffic citation and are found not guilty. Can the Civil Assessment be Vacated? You may request the Court to vacate the Civil Assessment if your failure to appear or pay was due to good cause such as: Hospitalization Incarceration Out of State - Military Duty Other; with a specific, documented occurrence You must first: 1. Fill out the Application to Vacate Civil Assessment; 2. Provide written documentation of the reason for your failure to appear or failure to pay, with supporting documentation. Examples of written documentation are: records of admission and discharge from the hospital; court orders to remand into custody/or records of release from custody; or appropriate military orders for active service. 3. On a failure to appear case you must post the bail amount for the original traffic citation at the time you submit your completed Application to the court for review. 4. On a failure to pay case you must pay all past due amount owing on your case at the time you submit your completed Application to the court for review. 1 American LegalNet, Inc. www.FormsWorkflow.com Fresno County Superior Court Application and Declaration to Vacate Civil Assessment (PC 1214.1) Helpful Information and Instruction Sheet What happens after the Application is filed? A Judicial Officer will review your Application. Once the Application with supporting documentation has been reviewed, the Application will either be granted or denied. If the Application is granted, the Civil Assessment will be vacated; and the Court will apply the bail amount to the fine on the original traffic violation. If the Application is denied, the Court will apply the bail amount to the Civil Assessment. You will be notified of the Court’s decision by mail. It is important that you supply the Court with your correct address and telephone number to ensure you receive the Court’s ruling on your Application to Vacate Civil Assessment. What if I also want to contest my traffic citation? The Civil Assessment is separate from your traffic citation; therefore, you must file a Request for Trial by Declaration to contest your traffic violation. Fill out the Request for Trial by Declaration form, and submit it with your Application to Vacate Civil Assessment. After deciding your Application, the Judicial Officer will review and decide your traffic case. You will be notified of the Court’s decision by mail. It is important that you supply the Court with your correct address and telephone number to ensure you receive the Court’s ruling on your Trial by Declaration. What if I was cited for a proof of correction on my original citation? The Civil Assessment is separate from your traffic citation; therefore, you must provide proof of correction along with your Application to Vacate form and post your original bail amount. After deciding your Application, the Court will review and determine if your proof of correction meets the criteria of acceptable proof. You will be notified of the Court’s decision by mail. It is important that you supply the Court with your correct address and telephone number to ensure you receive the Court’s ruling on your proof of correctable violations 2 American LegalNet, Inc. www.FormsWorkflow.com