(FOR COURT USE ONLY) PETITIONER OR ATTORNEY FOR PETITIONER (Name, State Bar number, and address): TELEPHONE NO.: FAX NO.(Optional): E-MAIL ADDRESS (Optional): ATTORNEY FOR (Name): SUPERIOR COURT OF CALIFORNIA, COUNTY OF SAN DIEGO CENTRAL DIVISION, COUNTY COURTHOUSE, 220 W. BROADWAY, SAN DIEGO, CA 92101 EAST COUNTY DIVISION, 250 E. MAIN ST., EL CAJON, CA 92020 NORTH COUNTY DIVISION, 325 S. MELROSE DR., VISTA, CA 92081 SOUTH COUNTY DIVISION, 500 3RD AVE., CHULA VISTA, CA 91910 PLAINTIFF PEOPLE OF THE STATE OF CALIFORNIA DEFENDANT SUPERIOR COURT CASE NUMBER CITY/DISTRICT ATTORNEY NUMBER PETITION FOR DISMISSAL PETITION Defendant hereby petitions for dismissal pursuant to Pen. Code § 1203.4 1203.4a. STATEMENT OF FACTS Defendant’s date of birth: of the following charges: Defendant was convicted on Probation was NOT granted granted by the court for a period of year(s) and ended on Defendant is entitled to the relief requested based on the following: Defendant has fulfilled the conditions of probation for the entire period of probation, OR granted early termination of probation, Defendant has been AND all of the following: (1) Defendant is not now serving a sentence on any offense. (2) Defendant is not on probation for any offense. (3) Defendant is not now charged with committing any offense. I certify under penalty of perjury under the laws of the State of California that the foregoing is true and correct. Dated: at by (City) (State) Petitioner / Attorney for Petitioner Petition filed must be served on the prosecuting agency. If the court grants the relief herein requested, defendant may have the right to petition for a Certificate of Rehabilitation and pardon pursuant to Pen. Code § 4852 et. seq. An information packet (SDSC #PKT-016) regarding this may be obtained from the court or found at www.sdcourt.ca.gov. NOTICE OF HEARING at Defendant’s petition will be heard on in Dept. . Clerk of the Superior Court Date:_______________________ Distribution by: ____________ on ____________ to SDSC CRM-204 (Rev. 7/09) , Deputy by Prosecutor – Courtesy Copy Defendant Probation PETITION FOR DISMISSAL Pre-trial Services Pen. Code §§ 1203.4, 1203.4a American LegalNet, Inc. www.FormsWorkFlow.com