NEV-0056 (rev 122314)APPLICATION FOR REVIEW OF CIVIL ASSESSMENT [Penal Code 247 1214.1] AND/OR DELINQUENT FINE PAYMENTSPage 1 of 2 SUPERIOR COURT OF THE STATE OF CALIFORNIA, COUNTY OF NEVADAPEOPLE OF THE STATE OF CALIFORNIA,IMPORTANT:Case NumberWritten proof of any of the following that supports your explanation for failing to pay thefine ordered must be attached or your application will be returned.HOSPITALIZEDAPPLICATION FOR REVIEW OF CIVILASSESSMENT [Penal Code 247 1214.1]AND/OR DELINQUENT FINE PAYMENTSThe following is an explanation of my failure(s) to pay the fine ordered: (Please print and include mandatory supporting attachments.)New payment amount ($Iam requesting the following relief:New payment start date (/mo.).Please state why you are making this request and list the facts in support of your request below:Attached number of pages:201 Church Street, Suite 7, Nevada City, CA 95959 (530) 265-131110075 Levon Avenue, Suite 107, Truckee, CA 96161 (530) 582-7835 vsDefendant: 1.REQUEST TO VACATE CIVIL ASSESSMENT/FAILURE TO PAY FINE INCARCERATEDMILITARY DUTYRESIDENTIAL TREATMENTDEATH CERTIFICATEOTHER EVIDENCE OF EXTRAORDINARY CIRCUMSTANCESCLERICAL ERRORNOT PERSON CITED2.REQUEST FOR REVIEW OF DELINQUENT FINE PAYMENTSPay fine with community service @ $10/hr. NOTE:Civil Assessment cannot be satisfied with community service.Pay in full without Civil Assessment onConvert fine to jail time (misdemeanors and felonies only). NOTE:Civil Assessment cannot be converted to jail time.Release hold on licenseOther:Ideclare under penalty of perjury under the laws of the State of California that all of the foregoing information, and allattachments, are true and correct to the best of my knowledge.AddressonCity and StateDateExecuted atTelephone #Signature: Note: It is mandatory to list all contact information requested. )001001001001001001001001001001001001001001001001001001 American LegalNet, Inc. www.FormsWorkFlow.com NEV-0056 (rev 122314)Page 2 of 2 THE COURT having read and considered the Application regarding review of Civil Assessment pursuant toDefendant222s Application for Review of Civil Assessment is GRANTED; Civil Assessment is vacated andDMV DL hold is released provided that the fine of $ORDER ON APPLICATION FOR REVIEW OF CIVIL ASSESSMENT [Penal Code 247 1214.1] AND/OR DELINQUENT FINE PAYMENTSPEOPLE OF THE STATE OF CALIFORNIA,201 Church Street, Suite 7, Nevada City, CA 95959 (530) 265-131110075 Levon Avenue, Suite 107, Truckee, CA 96161 (530) 582-7835SUPERIOR COURT OF THE STATE OF CALIFORNIA, COUNTY OF NEVADA vsCase NumberDefendant:ORDER ON APPLICATION FORREVIEW OF CIVIL ASSESSMENT[Penal Code 247 1214.1] AND/ORDELINQUENT FINE PAYMENTS Penal Code 247 1214.1 and/or Review of Delinquent Fine Payment(s), hereby makes the following order:is paid in full on or before.Defendant222s Application for Review of Civil Assessment is DENIED.Defendant222s Application for Review of Delinquent Fine Payment(s) is DENIED;Delinquent fine(s) to remain with GC Services.Defendant222s Application for Review of Delinquent Fine Payment(s) is GRANTED as follows:Other orders:DateSignature Judicial OfficerCommissionerFor questions regarding fine balance, please contact the appropriate court location listed above. 001001001001001001001001001 American LegalNet, Inc. www.FormsWorkFlow.com