SUPERIOR COURT OF CALIFORNIA, COUNTY OF STANISLAUS Street Address: 801 10 Street, 4 Floor , Modesto, CA 95354 th th th th FOR COURT USE ONLY Civil Clerk's Office: 801 10 Street, 4 Floor, Modesto, CA 95354 Telephone: (209) 530-3100 CASE TITLE: NOTICE RE: CIVIL ASSESSMENT CCP § 1993 CASE NUMBER: TO: ___________________________________________________________________ You are hereby notified that you failed to appear in court on _______________________ at ____________ a.m./p.m. in Dept. ________ pursuant to the Promise to Appear signed by you on _____________________________________. You are further notified that the court has ordered a civil assessment against you in the amount of $___________________, to be paid to the Stanislaus County Superior Court on or before __________________________. Said assessment will become effective unless you appear on __________________ at ____________a.m./p.m. in Dept. ___________, and show good cause for the failure to appear. Date: _________________ Clerk, by ___________________________, Deputy CLERK'S CERTIFICATE OF MAILING I certify that I am not a party to this cause and that a true copy of the Failure to Appear Notice was mailed first class, postage fully prepaid, in a sealed envelope addressed as shown below, and that the notice was mailed at Modesto, California, on: Date: _________________ Clerk, by ___________________________, Deputy CV014 Optional Form Rev 05/08 American LegalNet, Inc. www.FormsWorkFlow.com