ATTORNEY OR PARTY WITHOUT ATTORNEY (Name and Address): TELEPHONE NO.: FOR COURT USE ONLY ATTORNEY FOR (Name): SUPERIOR COURT OF CALIFORNIA, COUNTY OF SANTA BARBARA STREET ADDRESS: CITY AND ZIP CODE: BRANCH NAME: PLAINTIFF: DEFENDANT: CASE NUMBER: Notice of Filing of Petition for Certificate of Rehabilitation and Pardon To the Governor of the State of California; District Attorney of Name of county (Note 1) ; ; Name of county (Note 2) District Attorney, County of District Attorney, County of District Attorney, County of You and Each of You Will Please Take Notice That On the , State of Name of county and state (Note 3) ; ; day , State of Name of county and state (Note 4) (Date you filed your petition for Certificate of Rehabilitation) of court for a Certificate , the undersigned filed a petition in the above-entitled of Rehabilitation and Pardon in accordance with the provisions of Chapter and that the said petition has by , 3.5, Title 6, Part 3 of the Penal Code of the State of California, said court been set for hearing on the at the hours of (Ask County Clerk) day of (Date set by County Clerk. He will inform you of date.) o'clock M. of said day, or as soon thereafter as the matter can be at the Courthouse, in the City (Ask County Clerk) heard, at its courtroom, department of (Name of city where hearing will be held) , County of , State of California. Dated (Month) (Day) (Year) [Sign Your Name Here] Optional Form SC-3058 [Rev. 01/01/05] (Petitioner) (Residence address) Page 1 of 4 American LegalNet, Inc. www.USCourtForms.com Receipt of copy of the within Notice is hereby admitted this . day of Governor of the State of California By Receipt of copy of the within Notice is hereby admitted this . day of District Attorney of County Receipt of copy of the within Notice is hereby admitted this . day of District Attorney of County Receipt of copy of the within Notice is hereby admitted this . day of District Attorney of County Receipt of copy of the within Notice is hereby admitted this . day of District Attorney of County Optional Form SC-3058 [Rev. 01/01/05] Page 2 of 4 American LegalNet, Inc. www.USCourtForms.com AFFIDAVIT OF SERVICE BY MAIL STATE OF CALIFORNIA ss. County of being first duly sworn deposes and says: I am a citizen of the United States, over the age of 18 years and am not a party to the aboveentitled proceeding. I am a resident of the County of , State of California. My residence/business address is Number Street City California. On of named: NAME ADDRESS the California, day of I served the within Notice , at upon the person County hereinafter by placing a copy of this Notice above indicated to each of aid in sealed envelopes, addressing persons, sealing prepaid thereon; that one envelope as herein said envelopes and or that there is then depositing the same a delivery service by a regular communication in the United States mail with postage fully there is United States mail at each of the places so addressed, by mail between the said place of mailing and each of the said places so addressed. Subscribed and sworn to before me this of day Notary Public In and for the Optional Form SC-3058 [Rev. 01/01/05] County of State of California Page 3 of 4 American LegalNet, Inc. www.USCourtForms.com NOTES (1) Fill in the name of the county in which you have filed your Petition. (2) Fill in name of the California county in which you were convicted of a felony. If this is the same as (1), you need not duplicate. If you have more than one felony conviction, fill in the county where last convicted. (3) Fill in the name of any other county in which you were convicted of a felony. (4) Fill in the name of any other county in which you were convicted of a felony. INSTRUCTION (a) Prepare this Notice and enough copies to serve all of the persons you have named. The Notice shall be given (1) to the Governor of California, (2) the District Attorney of the county in which you filed your petition, and (3) to the District Attorney of each county in which you were convicted of a felony. (b) This Notice must be served at least 30 days prior to the date set for the hearing. (c) On the reverse side of this Notice are forms for proof of service upon various persons indicated above. This can be done by delivering a copy to each one, and having them sign for the same in the blanks indicated, or by having someone, other than yourself, mail a copy to each and making the affidavit of mailing, which is also set out on the reverse side of this Notice. Mailing procedure is explained in the affidavit itself. (d) After you have served all of the persons indicated, personally or by mail, or a combination of both, file this Notice with the County Clerk, together with the admission of service or the affidavit of mailing, or a combination of both, as the case may be. (e) If the county is San Francisco, insert the words "City and" in front of the word "County." Law reference: Sections 4852.01 to 4852.2, inclusive, Penal Code of California. Optional Form SC-3058 [Rev. 01/01/05] Page 4 of 4 American LegalNet, Inc. www.USCourtForms.com