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SUPERIOR COURT OF CALIFORNIA, COUNTY OF MENDOCINO Ukiah 100 North State St Ukiah, CA 95482 PLAINTIFF: People of the State of California DEFENDANT: ADDRESS: Charge(s): Ten Mile 700 South Franklin St. Fort Bragg, CA 95437 FOR COURT USE ONLY REQUEST TO CALENDAR CASE In Custody I Probation Officer CRIMINAL TRAFFIC CASE NUMBER: , Defendant Attorney for Defendant Deputy District Attorney Court Clerk request that this matter be placed on calendar as follows: Calendar date: Reason: Dept: Time: Modification: New Surrender Date (attach declaration)** Modification: Re-referral 1st offender DUI Program (attach declaration)** Violation of Probation (Arraignment) Modification of Probation (attach declaration)** Termination of Probation (declaration and proper motion must be attached) Modification of Sentence (attach declaration)** Modification: Extend Time to Pay (attach declaration)** Modification: Re-referral Multiple Offender DUI Program (attach declaration)** Modification: Ignition Interlock (attach declaration)** Withdraw Plea/Dismiss 1203.4 PC (proper motion must be attached) Modification: Fine to C/S* hours (attach declaration)** Recall Bench Warrant (attach declaration)** Warrant Arraignment (attach declaration)** Modification: Extension on C/S* hours (declaration and progress report must be attached) Advance Hearing Other: Proof of Mailing Attached Proof of Service Attached ** DECLARATIONS ON THE FORM PROVIDED MUST BE ATTACHED TO ANY REQUESTS AS NOTED ABOVE. REQUEST WILL NOT BE FILED OR SUBMITTED TO THE COURT WITHOUT THE DECLARATION ATTACHED. Defendants/Parties are advised to check the posted calendar on the court date as departments are subject to change. I declare, under the penalty of perjury under California State law, that the information is true and correct. Dated: Signature of Requesting Party Telephone Number . If defendant has an outstanding warrant, he/she has been informed that the warrant remains active and he/she is subject to arrest. IT IS HEREBY ORDERED In Custody Request to Calendar is: Date: By: Granted Denied , Judicial Officer Note: Case may not be placed on calendar for consideration of Sheriff's decision on denying Work Release, Work Furlough, Home Monitoring, or Sheriff's Parole. CC: Via FAX to Jail MCR-103-local (rev 0110) REQUEST TO CALENDAR CASE *C/S = Community Service American LegalNet, Inc. www.FormsWorkFlow.com