., Banning, CA 92220 4100 Main St., Riverside, CA 92501 265 N. Broadway, Blythe, CA 92225 30755-D Auld Rd., Ste. 1226, Murrieta, CA 92563 46-200 Oasis St., Indio, CA 92201 ATTORNEY OR PARTY WITHOUT ATTORNEY TELEPHONE NO.: E-MAIL ADDRESS: ( ATTORNEY FOR FAX NO. DEFENDANT: PEOPLE OF THE STATE OF CALIFORNIA vs. CASE NUMBER: CII: Driver222s License Number: SSN# (Last four digits only): Date of Birth: 1. On () : The defendant in the above-entitled criminal action was convicted of a violation of section(s) (specify): Code. 2. More than a year has elapsed since the date of pronouncement of judgment. The defendant has compled with the sentence of the court and is not serving a sentence for any offense nor under charge of commission of any crime, and since said pronouncement of judgment has lived an honest and upright life and conformed to and obeyed the laws of the land. 3. The petitioner has given the prosecuting attorney at least 15 days of notice of the Petition for Dismissal. Petitioner requests that defendant be permitted to withdraw the plea of guilty, or that the verdict or finding of guilt be set aside and a plea of not guilty entered and the court dismiss this action under Section 1203.4a(d) of the Penal Code. I declare under penalty of perjury under the laws of the State of California that the information above is true and correct. Date: (TYPE OR PRINT NAME OF ATTORNEY PARTY MAKING DECLARATION) (SIGNATURE) (ADDRESS, DEFENDANT) (CITY) (STATE) (ZIP) Approved for Optional Use Riverside Superior Court RI-R00 [Rev. //11] Penal Code 1203.4a(d) riverside.courts.ca.gov/localfrms/localfrms.shtml American LegalNet, Inc. www.FormsWorkFlow.com