600 Union Avenue 321 Tuolumne Street Fairfield, CA 94533 Vallejo, CA 94590 (707) 207 - 7360 (707) 561 - 7860 DECLARATION FORM INSTRUCTIONS (For Submission, Modification, or Reconsideration) A separate declaration must be completed for each case. Current address and telephone number are required. This information will be used concerning your case. Mark the box or boxes which best describes what you are requesting of the Court. If you are requesting a lower fine, an extension to pay , a payment plan, dismissal of charge(s) or late fees, or community service, you are requested to provide current proof of income or other means of financial support. Examples of supporting documentation may include, but is not limited to, evidence of publi c benefits or government assistance, evidence of monthly income, and/or evidence of disability. Inability to Pay : To ask the court to consider your ability to pay due to financial hardship and to decide whether to approve a lower fine, a payment plan or co mmunity service, you may be schedule d for an appearance in court without deposit of bail If you are requesting credit for time served, please submit a booking summary or court order that outlines the location and amount of time served. If you are asking the Court to dismiss late fees for Failure to Appear, Failure to Pay, or the $300 Civil Assessment, be sure to give the reason(s) for your failure to appear/pay. Please note that applicable proof must be attached and coincide with the time period in quest ion. If you are a full - time student, a copy of your class schedule is also required. A plea of guilty/not guilty must be entered for all charges. If it is your intent to plead guilty, please date and sign the Entry of Plea and Waiver of Rights Declara tion Form attached. Sign and date your declaration. Faxed Declarations will not be accepted. American LegalNet, Inc. www.FormsWorkFlow.com [ ] Hall of Justice [ ] Solano Justice Center 600 Union Avenue 321 Tuolumne Street P.O. Box 2463 Vallejo, CA 94590 Fair field, CA 94533 (707) 561 - 7860 (707) 207 - 7360 Mandatory Form 4809 - TR Page 1 of 2 Case Number: If you have more than one case, use one form for each case. Name: Street or Mailing Address: City: State: Zip: Tel. : Date of Birth : E - mail ( optional) : GC Clerk fills out this box FTA FTP A Traffic School Certificate was filed. $ Amount ordered Due date $ Amount paid Date paid Balance due: $ (Check all that apply to your request . ) 1. Lower the fine 4. Payment plan 8 . Release DMV License Hold (Abstract) 2. Extend deadline to pay 5. Dismiss the fine/charge 9 . Accept Proof of Correction 3. Credit for time served 6. Community Service 10. Dismiss late fee ($300 Civil Assessment) in jail or residential . Ask for a Court Date 11 . Other ( specify): treatment program (Check all that apply . ) Hospitalization Death of Immediate Family Member Could not afford to p ay on due date Physically Incapacitated In Jail or Residential Treatment Program Military Absence Other (specify): Important! Attach a copy of that proves you were unable to appear or pay when scheduled to do so . Use the space in Item 8 to explain the reasons you checked for your failure to appear or pay. (Skip Sections 5 and 6 ; Complete Sections 7 , 8 and 9 ) (If you check this box, you must also fill out Sections 5 , 6 * , 7 , 8 and 9 .) Ch eck any benefits listed below that you are receiving . If you do not receive benefits, go to the next question . Medi - Cal CalFresh/WIC CalWorks CAPI SSI/SSP Low - Income Veterans Pension Tribal TANF Refugee Cash Assistance General Assistance Extended Foster Care IHSS Other need - based help (specify): Important! Attach a copy of that proves you are getting the benefits you checked. If you are homeless, live in a shelter, or in a transitional living facility , check below. Homeless (Where do you usually sleep?): Shelter or Transitional living facility ( Which one? ): American LegalNet, Inc. www.FormsWorkFlow.com Case Number: Mandatory Form 4809 - TR Page 2 of 2 (skip this section if you checked any public b enefits in Item 4 or any box in I tem 5 ) Monthly income $ Number of people in household: Important! Attach a copy of that proves the amount of gross - monthly income (before tax deductions) for your household. In Item 8 , provide any details or special circumstances you want the court to consider. Please explain the reason for your request and why you previously failed to appear or pay. I nclude any details or special circ umstances you want the court to consider (Attach more pages if you need more space.) I declare under penalty of perjury under the laws of the State of the California that the information I have provided on this form is true and correct. Date: Applicant s ign s here Submitted by: Clerk Name [ ] Granted No (s). Deadline to Pay Extended: 3 Months 6 months [ ] Denied No (s). [ ] Fine reduced to: [ ] Other Orders Date: JUDICIAL OFFICER/DIVISION MANAGER American LegalNet, Inc. www.FormsWorkFlow.com FORM 4874 - TR Page 1 of 1 MANDATORY Superior Court of California Traffic Division Solano County Case No. Plea Form (Infractions) Fill out this form if: You accept the charges on your infraction ticket, You want to plead guilty or no contest in this case , and You want to plead using this form instead of going to court. 1 Your Information Name: Case Number: Street or Mailing Address: Tel.: Email (optional): Date of Birth: 2 Charges I am pleading guilty or no contest to the following traffic infraction(s): Section and Code: 3 You have the following rights: To have a lawyer represent you (at your expense). To an interpreter if you do not speak English well. To a speedy court trial within 45 days of your first court date. At that trial, you have the right to not testify against yourself, to subpoena witnesses to testify for your case, and to see and question witnesses. 4 If you check Guilty or No contest below, that means: You accept the charge(s) on the ticket. There will not be a trial or witnesses. You give up the rights explained on this form. no contest the incident. 5 Your Plea Check one: Guilty No Contest I declare under penalty of perjury under the laws of the State of the California that there are facts to support my plea, and that the information I have provided on this form is true and correct. Date: Sign here American LegalNet, Inc. www.FormsWorkFlow.com