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Petition For Certificate Of Rehabilitation And Pardon Form. This is a California form and can be use in Orange Local County.
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Tags: Petition For Certificate Of Rehabilitation And Pardon, L-408.1, California Local County, Orange
FOR COURT USE ONLY
ATTORNEY OR PARTY WITHOUT ATTORNEY (Name & Address):
Telephone No.:
E-Mail Address (Optional):
ATTORNEY FOR (Name):
Fax No. (Optional):
Bar No:
SUPERIOR COURT OF CALIFORNIA, COUNTY OF ORANGE
CENTRAL JUSTICE CENTER
700 CIVIC CENTER DRIVE WEST
POST OFFICE BOX 22024
SANTA ANA, CA 92702-2024
In the Matter of the Application of
________________________________________________________________
Type Petitioner’s full name – First Middle Last and Suffix, if applicable
Date of Birth:
CII Number:
Criminal Case Number(s):
PETITION FOR CERTIFICATE OF REHABILITATION AND PARDON
(Penal Code § 4852.01 et seq.)
CASE NUMBER:
M-
To the Superior Court of California, County of Orange:
The above-named petitioner represents and shows that:
CONVICTION HISTORY
[All qualifying convictions must be listed. If you have more than three (3) qualifying convictions, attach additional sheets following the same format.]
Most Recent Qualifying Conviction
(A)
Offense
On or about
Month Day, Year
on case number:
, petitioner was convicted of the crime of
in the County of
Indicate Crime and Code Section
, California.
(B)
Type of Sentence or Disposition
Petitioner’s sentence for this offense was:
[Check the appropriate box]
Commitment to state prison or other state institution at
Name of institution or city where located
;
Sentenced to state prison, but execution of sentence was suspended and petitioner was placed on probation.
Imposition of sentence was suspended and petitioner was placed on probation.
Page 1 of 5
PETITION FOR CERTIFICATE OF REHABILIATION AND PARDON
Optional Use
Form: L-408.1 [Rev. July 15, 2011]
Penal Code, §§ 4852.01
and 4852.06
American LegalNet, Inc.
www.FormsWorkFlow.com
Name:
Case Number:
M-
(C)
Date of Release
Thereafter, on or about
Date released from custody
, petitioner was;
[Check the appropriate box(es)]
Discharged from state prison or other state institution after completing his/her sentence on
Released on parole on
(date).
(date).
Released from custody on probation (after serving a jail sentence as a condition of probation)
on __________________(date).
Released on probation (if no jail sentence was imposed) on __________________(date).
(D)
Pen. Code § 1203.4 History (For Probationers Only)
a) After termination of probation on ______________, a petition for relief under Penal Code section 1203.4
was granted on __________________(date).
b) Has petitioner been incarcerated in any prison, jail, detention facility, or other penal institution or agency
after his/her Penal Code section 1203.4 petition was granted? Yes_____ No_____
c) If yes, when and where? _______________________________.
d) Is petitioner currently on probation for the commission of any other felony? Yes_____ No_____
e) Petitioner presents the following evidence that he/she has resided in California for the past five years
(supporting documentation may be attached as exhibits to the petition):
.
.
.
Second Most Recent Qualifying Conviction
(A)
Offense
On or about
Month Day, Year
on case number:
, petitioner was convicted of the crime of
in the County of
Indicate Crime and Code Section
, California.
(B)
Type of Sentence or Disposition
Petitioner’s sentence for this offense was:
[Check the appropriate box]
Commitment to state prison or other state institution at
Name of institution or city where located
;
Sentenced to state prison, but execution of sentence was suspended and petitioner was placed on probation.
Imposition of sentence was suspended and petitioner was placed on probation.
Page 2 of 5
PETITION FOR CERTIFICATE OF REHABILIATION AND PARDON
Optional Use
Form: L-408.1 [Rev. July 15, 2011]
Penal Code, §§ 4852.01
and 4852.06
American LegalNet, Inc.
www.FormsWorkFlow.com
Name:
Case Number:
M-
(C)
Date of Release
Thereafter, on or about
Date released from custody
, petitioner was;
[Check the appropriate box(es)]
Discharged from state prison or other state institution after completing his/her sentence on
Released on parole on
(date).
(date).
Released from custody on probation (after serving a jail sentence as a condition of probation)
on __________________(date).
Released on probation (if no jail sentence was imposed) on __________________(date).
(D)
Pen. Code § 1203.4 History (For Probationers Only)
a) After termination of probation on ______________, a petition for relief under Penal Code section 1203.4
was granted on __________________(date).
b) Has petitioner been incarcerated in any prison, jail, detention facility, or other penal institution or agency
after his/her Penal Code section 1203.4 petition was granted? Yes_____ No_____
c) If yes, when and where? ______________________________
d) Is petitioner currently on probation for the commission of any other felony? Yes_____ No_____
e) Petitioner presents the following evidence that he/she has resided in California for the past five years
(supporting documentation may be attached as exhibits to the petition):
.
.
.
Third Most Recent Qualifying Conviction
(A)
Offense
On or about
Month Day, Year
on case number:
, petitioner was convicted of the crime of
in the County of
Indicate Crime and Code Section
, California.
(B)
Type of Sentence or Disposition
Petitioner’s sentence for this offense was:
[Check the appropriate box]
Commitment to state prison or other state institution at
Name of institution or city where located
;
Sentenced to state prison, but execution of sentence was suspended and petitioner was placed on probation.
Imposition of sentence was suspended and petitioner was placed on probation.
Page 3 of 5
PETITION FOR CERTIFICATE OF REHABILIATION AND PARDON
Optional Use
Form: L-408.1 [Rev. July 15, 2011]
Penal Code, §§ 4852.01
and 4852.06
American LegalNet, Inc.
www.FormsWorkFlow.com
Name:
Case Number:
M-
(C)
Date of Release
Thereafter, on or about
Date released from custody
, petitioner was;
[Check the appropriate box(es)]
Discharged from state prison or other state institution after completing his/her sentence on
Released on parole on
(date).
(date).
Released from custody on probation (after serving a jail sentence as a condition of probation)
on __________________(date).
Released on probation (if no jail sentence was imposed) on __________________(date).
(D)
Pen. Code § 1203.4 History (For Probationers Only)
a) After termination of probation on ______________, a petition for relief under Penal Code section 1203.4
was granted on __________________(date).
b) Has petitioner been incarcerated in any prison, jail, detention facility, or other penal institution or agency
after his/her Penal Code section 1203.4 petition was granted? Yes_____ No_____
c) If yes, when and where? __________________
d) Is petitioner currently on probation for the commission of any other felony? Yes_____ No_____
e) Petitioner presents the following evidence that he/she has resided in California for the past five years
(supporting documentation may be attached as exhibits to the petition):
.
.
.
RESIDENCY HISTORY
I am now a resident of the State of California, and I have continuously resided in the State of California
, to the present date.
from
I currently reside in the County of _______________________ at the following address:
Page 4 of 5
PETITION FOR CERTIFICATE OF REHABILIATION AND PARDON
Optional Use
Form: L-408.1 [Rev. July 15, 2011]
Penal Code, §§ 4852.01
and 4852.06
American LegalNet, Inc.
www.FormsWorkFlow.com
Name:
Case Number:
M-
PETITIONER’S DECLARATION
During the period of my rehabilitation, I have lived an honest and upright life, conducted myself with
sobriety and industry, and exhibited good moral character. I have conformed to and obeyed all the laws
of the land.
I request that the Court make its order declaring that I have been rehabilitated; and for a Certificate of
Rehabilitation recommending that the Governor of the State of California grant me a full pardon.
I declare under penalty of perjury under the laws of the State of California that the foregoing information
is true and correct.
Date
SIGNATURE OF PETITIONER
TYPE OR PRINT NAME OF PETITIONER
Page 5 of 5
PETITION FOR CERTIFICATE OF REHABILIATION AND PARDON
Optional Use
Form: L-408.1 [Rev. July 15, 2011]
Penal Code, §§ 4852.01
and 4852.06
American LegalNet, Inc.
www.FormsWorkFlow.com
