SUPERIOR COURT OF CALIFORNIA COUNTY OF PLACER THE PEOPLE OF THE STATE OF CALIFORNIA, CASE NO. _____________ CII NO. ________________ vs. PETITION PURSUANT TO: PC 1203.4a (Dismissal) __________________________________________, Defendant. I, the undersigned, declare that I am the defendant in the above-entitled criminal action. I hereby request that I be able to withdraw my plea of guilty or nolo contendere and a plea of not guilty be entered. PC 1203.4a – MISDEMEANOR CONVICTION - PROBATION NOT GRANTED: Probation was not granted. More than one year has elapsed since the date sentence was imposed. I have fully complied with and performed the sentence imposed by the Court. I am not serving a sentence for any offense. I am not under charge of commission of any crime. Since imposition of sentence, I have lived an honest and upright life. I have conformed to and obeyed the laws of the land. A person who petitions for a dismissal of a charge under section 1203.4a may be required to reimburse the county and the court for the cost of services rendered at a rate to be determined by the county board of supervisors for the county and by the court for the court, not to exceed $60.00, and to reimburse any city for the cost of services rendered at a rate to be determined by the city council not to exceed $60.00. Ability to make this reimbursement shall be determined by the court and shall not be a prerequisite to a person’s eligibility under this section. A person who petitions for a dismissal of a charge under section 1203.4a may be required to reimburse the county and the court for the cost of services rendered at a rate to be determined by the county board of supervisors for the county and by the court for the court, not to exceed $60.00, and to reimburse any city for the cost of services rendered at a rate to be determined by the city council not to exceed $60.00. Ability to make this reimbursement shall be determined by the court and shall not be a prerequisite to a person’s eligibility under this section. I declare under penalty of perjury under the laws of the State of California that the foregoing is true and correct. Dated: __________________________________ Signed:____________________________________ Date of birth: ___________________________ Address:____________________________________ _______ ____________________________ PROOF OF SERVICE: At the time of service I was at least 18 years of age. I served a copy of this U. S. mail or personal service to the office of the Placer County District Attorney, document by 11562 B Avenue, Auburn, CA. 95603 Placer County Probation Department, 11564 C Avenue, Auburn, CA. 95603 American LegalNet, Inc. www.FormsWorkflow.com