SUPERIOR COURT OF CALIFORNIA, COUNTY OF SANTA BARBARA Santa Barbara Division 118 East Figueroa St. Santa Barbara, CA 93101 (805) 568-3959 PLAINTIFF: DEFENDANT: FOR COURT USE ONLY Santa Maria Division 312 East Cook St. Bldg. E Santa Maria, CA 93454 (805) 346-7550 Lompoc Division 115 Civic Center Plaza Lompoc, CA 93436 (805) 737-7789 People of the State of California ABILITY TO PAY DETERMINATION CITATION NUMBER: INSTRUCTIONS: THIS FORM MAY ONLY BE SUBMITTED ONCE TO THE COURT. Full Name Last: First: Middle: Suffix: Current Address Street: City: State: Zip: Additional Information: Telephone Number: Driver's License #: I am pleading guilty I am requesting Traffic School (if eligible); I have a financial hardship and I cannot pay the full amount for the offenses on my citation. I am requesting a judicial determination regarding my ability to pay. Attached is my financial affidavit. I understand certain fines are mandated by the legislature and may be ineligible for reduction. I am requesting a reduction in the monthly installment payment amount to $_____________ per month. I am requesting a reduction in the fine that has already been imposed on this case. I declare under penalty of perjury that the foregoing is true and correct. Dated: DEFENDANT IT IS SO ORDERED: Fine of $ imposed, due within 30 days of the date of mailing of this notice, or to be paid to the court by the Due by of every month. . Monthly payments of $ Traffic School is authorized (additional $66.00 traffic violator school fee will be imposed.) Defendant to appear in court on at a.m. / p.m. in Dept Denied. The court has determined the defendant has the ability to pay. Payments may be arranged through the Traffic Department. Other: Dated: JUDICIAL OFFICER OF THE SUPERIOR COURT \ CLERK'S CERTIFICATE OF MAILING I certify that I am not a party to this action and that a true copy of the foregoing was mailed first class, postage prepaid, in a sealed envelope addressed as shown, and that the mailing of the foregoing and execution of this certificate occurred at Santa Barbara Santa Maria Lompoc, California on (date): ________________, Darrel E. Parker, Executive Officer SC-8028 [Revised Dec. 2016] \ By ABILITY TO PAY DETERMINATION , Deputy American LegalNet, Inc. www.FormsWorkFlow.com