Attorney or Party Without An Attorney (Name, State Bar No. & Address) FOR COURT USE ONLY Telephone No. Attorney for: NAME OF COURT: SUPERIOR COURT OF CALIFORNIA, COUNTY OF SAN BERNARDINO STREET ADDRESS: MAILING ADDRESS: CITY, STATE ZIP: DISTRICT NAME: PEOPLE OF THE STATE OF CALIFORNIA vs. DEFENDANT: CASE NUMBER REQUEST FOR SENTENCE MODIFICATION AND ORDER INSTRUCTIONS: This form may be submitted to the Court and must have all supporting documentation attached at the time it is submitted to the judicial officer. Failure to do so may result in an automatic denial. What do you want the court to do? Modify my sentence to allow me to attend Traffic School even though it was not initially ordered. (If approved, I will be required to pay a $60.00 administrative fee to the court before attending the school). Modify my sentence to grant an extension. (If approved, I will be required to pay a $30.00 extension fee). Modify my sentence to allow a payment plan. (If approved, I will be required to pay a $35.00 administrative fee). Modify my sentence to convert community service back to a fine. (If approved, I will be required to pay a $30.00 administrative fee). I declare under penalty of perjury that the foregoing statement is true and correct to the best of my knowledge and that written proof is attached to this form as required. SIGNATURE OF DEFENDANT IT IS ORDERED: APPROVED Upon payment of $60.00 and balance of fines to the court, you may attend Traffic School if eligible. You are granted an extension of time to to complete your sentence. ($30.00 admin fee added.) Payment Plan is granted at the rate of _________ per month beginning _____________. ($35.00 admin fee added.) DENIED OTHER DATE JUDICIAL OFFICER SIGNATURE IF YOU FAIL TO PAY, AN ADDITIONAL $300 CIVIL ASSESSMENT PLUS PENALTIES WILL BE APPLIED TO YOUR CASE. OTS-CRTIAF-BLANK-RC-20140404 REQUEST FOR SENTENCE MODIFICATION Form #21284 Page 1 of 1 American LegalNet, Inc. www.FormsWorkFlow.com