IN THE SUPERIOR COURT OF THE STATE OF CALIFORNIA IN AND FOR THE COUNTY OF SAN BERNARDINO In the Matter of the Application of NO. CII No. (Print or write your name legibly) For a Certification of Rehabilitation and Pardon Date of Birth CERTIFICATE OF REHABILITATION The petition of at , presently residing , heretofore filed, praying for a Certificate of Rehabilitation pursuant to the provisions of Chapter 3.5, Title 6 of Part 3 of the Penal Code of the State of California, came on regularly for hearing on this day of , , and proof having been made to the satisfaction of the Court that notice of the time of hearing has been regularly given as required by law; and from satisfactory proof taken at said hearing the Court finds that all allegations of said petition are true, and that the required period of rehabilitation has elapsed since petitioner's date of discharge from custody due to this completion of the term to which he was sentenced, or upon his release on parole or probation on , , that, where appropriate, petitioner has obtained relief pursuant to Penal Code section 1203.4, and that petitioner has demonstrated by his course of conduct his rehabilitation and fitness to exercise all the civil and political rights of citizenship (except as provided in Penal Code section 4852.15); and that petitioner has been (once) (twice) (thrice) convicted of a felony; WHEREFORE, It Is Ordered, Adjudged and Decreed, And this Court does hereby order, adjudge and decree that petitioner has been rehabilitated and is fit to exercise all the civil and political rights of citizenship (except as provided in Penal Code Section 4852.15), and by virtue thereof this court recommends that the Governor of the State of California grant a full pardon to said petitioner. Done in open court this day of , . Judge of said Superior Court This form is prepared under the direction of the office of the Attorney General of the State of California. ACIS Code 1096(1) SB-19720 13-19720-360 2002 � American LegalNet, Inc.