Madera Superior Court Form Adopted for Optional Use MAD-CRM-0009 (Rev. 3/11/19) NOTICE OF FILIN G OF PETITION FOR CERTIFICATE OF REHABILITATION AND PARDON Page of 4 ATTORNEY OR PARTY WITHOUT ATTORNEY (Name, Address, Telephone No.) ATTORNEY FOR (Name): FOR COURT USE ONLY SUPERIOR COURT OF CALIFORNIA, COUNTY OF MADERA Madera - 200 South G Street Madera, CA 93637 PEOPLE OF THE STATE OF CALIFORNIA VS. Defendant: In re the Application of : (Print or type your name legibly) For a Certificate of Reh abilitation and Pardon NOTICE OF FILING OF PETITION FOR CERTIFICATE OF REHABILITATION AND PARDON Case Number: To the Governor of the State of California; District Attorney of ; Name of County (Note 1) District Attorney , County of ; Name of County (Note 2) District Attorney, County of , State of ; Name of County and State (Note 3) District Attorney, County of , State of ; Name of County and State (Note 4) Y OU AND E ACH OF Y OU W ILL P LEASE T AKE N OTICE T HAT ON THE day of , 20 , (Date you filed your Petition for Certificate of Rehabilitation) the undersigned filed a petition in the above-entitled court for a Certificate of Rehabilitation and Pardon in accordance with the provisions of Chapter 3.5, Title 6, Part 3 of the Penal Code of the State of California, and that the said petition has by said court been set for hearing the day of , 20 , at the hours of o222clock .m. of said day, or as (Ask Clerk of the Court) soon thereafter as the matter can be heard, at its courtroom, Department at the (Ask Clerk of the Court) Courthouse, in the City of , County of , State of California. (Name of city where hearing will be held.) DATED: , 20 Signature of Petitioner Residence Address American LegalNet, Inc. www.FormsWorkFlow.com Madera Superior Court Form Adopted for Optional Use MAD-CRM-0009 (Rev. 3/11/19) NOTICE OF FILIN G OF PETITION FOR CERTIFICATE OF REHABILITATION AND PARDON Page of 4 Receipt of copy of the within notice is hereby admitted this day of , 20 . Governor of the State of California By Receipt of copy of the within notice is hereby ad mitted this day of , 20 . District Attorney of County Receipt of copy of the within notice is hereby admitted this day of , 20 . District Attorney of County Receipt of copy of the within notice is hereby admitted this day of , 20 . District Attorney of County Receipt of copy of the within notice is hereby admitted this day of , 20 . District Attorney of County AFFIDAVIT OF SERVICE BY MAIL American LegalNet, Inc. www.FormsWorkFlow.com Madera Superior Court Form Adopted for Optional Use MAD-CRM-0009 (Rev. 3/11/19) NOTICE OF FILIN G OF PETITION FOR CERTIFICATE OF REHABILITATION AND PARDON Page of 4 STATE OF CALIFORNIA County of } SS being first duly sworn deposes and says: I am a citizen of the United States, over the age of 18 years and am not a party to the above-entitled proceeding. I am a resident of the County of , State of Califo rnia. My residence/ business address is , California. On the day of , 20 , at County of , California, I served th e within Notice upon the person hereinafter named: NAME ADDRESS by placing a copy of this Notice in sealed envelopes, addressing one envelope as herein above indicated to each of said persons, sealing said envelopes and then depositing the same in the United States mail with postage fully prepaid thereon; that there is a delivery service by the United States mail at each of the places so addressed, or that there is a regular communication by mail between the said place of mailing and each of the said places so addressed. Signature of Declarant Subscribed and sworn before me this day of 20 Notary Public In and f o r the County of , the State of California NOTES (1) Fill in the name of the county in which you have filed your Petition. American LegalNet, Inc. www.FormsWorkFlow.com Madera Superior Court Form Adopted for Optional Use MAD-CRM-0009 (Rev. 3/11/19) NOTICE OF FILIN G OF PETITION FOR CERTIFICATE OF REHABILITATION AND PARDON Page of 4 (2) Fill in the name of the California county in which you were convicted of a felony. If this is the same as (1), you need not duplicate. If you have more than one felony conviction, fill in the county where last convicted. (3) Fill in the name of any other county in which you were convicted of a felony. (4) Fill in the name of any other county in which you were convicted of a felony. 227227227227ooOoo227227227227 INSTRUCTIONS (a) Prepare this Notice and enough copies to serve all of the persons you have named. The Notice shall be given (1) to the Governor of California, (2) the District Attorney of the county in which you filed your petition, and (3) to the District Attorney of each county in which you were convicted of a felony. (b) This Notice must be served at least 30 days prior to the date set for the hearing. (c) On the reverse side of this Notice are forms for proof of service upon various persons indicated above. This can be done by delivering a copy to each one, and having them sign for the same in the blanks indicated, or by having someone, other than yourself, mail a copy to each and making the affidavit of mailing, which is also set out on the reverse side of this Notice. Mailing procedure is explained in the affidavit itself. (d) After you have served all of the persons indicated, personally or by mail, or a combination of both, file this Notice with the Clerk of the Court, together with the admission of service or the affidavit of mailing, or a combination o both, as the case may be. Law reference: Sections 4852.01 to 4852.2, inclusive, Penal Code of California. American LegalNet, Inc. www.FormsWorkFlow.com