VN075 IN THE SUPERIOR COURT OF THE STATE OF CALIFORNIA IN AND FOR THE COUNTY OF _____________________ In the Matter of the Application of _________________________________ (Print your name legibly) No. ___________________________ For a Certificate of Rehabilitation and Pardon PETITION FOR CERTIFICATE OF REHABILITATION AND PARDON To the Honorable Superior Court of the State of California, in and for the county of __________________________________________________________________ : The petition of ________________________________________________________ hereby respectfully represents and shows that: (Fill in your name) I. (Complete this paragraph only with respect to your most recent felony conviction) On or about ___________________________________________ , ____________ I was convicted of the felony of _______________________________________________________________________________ in the (State crime and code section if you know it) County of _______________________________________________________, State of California. My sentence for this offense was (check appropriate box): [ ] commitment to state prison or other state institution ] probation with at __________________________________________________________________________ ; [ a suspended sentence to state prison or other state institution. Optional Form VN075 (Rev. 07/12) PETITION FOR CERTIFICATE OF REHABILITATION AND PARDON Page 1 of 4 American LegalNet, Inc. www.FormsWorkFlow.com VN075 Thereafter, on or about _________________________________________ , ____________________ , I was (date of release from actual custody) (check appropriate box): [ [ ] discharged from state prison or other state institution after completing my sentence; ] released on parole, from which I was finally discharged on _________________________________________ ] released from custody on probation or after serving a jail sentence _______________________ , ____________. [ as part of my probation, successfully completed my probation on ____________________________________________ _______ , ___________ , and obtained relief under Penal Code section 1203.4 on ____________________________ ___________________________ , ____________ . Note 1 (Complete this section with respect to your second most recent felony conviction, if any.) On or about ____________________________________________ , ______________ I was convicted of the felony of ______________________________________________________________________________ , in the (State crime and code section if you know it) County of _____________________________________________________ , State of California. My sentence for this offense was (check appropriate box): [ ] commitment to state prison or other state institution ] probation with at ________________________________________________________________ ; [ a suspended sentence to state prison or other state institution. Thereafter, on or about _______________________________________________________________ , I was (date of release from actual custody) (check appropriate box): [ sentence; [ ] discharged from state prison or other state institution after completing my ] released on parole, from which I was finally discharged on __________________________________ ] probation or after serving a jail sentence as part of my probation, ______________________ , _____________; [ successfully completed my probation on ________________________________________________ , __________ and obtained relief under Penal Code section 1203.4 on ____________________________________________________ , ____________________ . Note 2 (Complete this section with respect to your third most recent felony conviction, if any.) On or about ___________________________________________ , ______________ , I was convicted of the felony of __________________________________________________________________________________ , in the (State crime and code section If you know it) County of _______________________________________________________ , State of California. My sentence for this offense was (check appropriate box): [ ] commitment to state prison or other state institution at ] probation with a _____________________________________________________________________ ; [ suspended sentence to state prison or other state institution. Optional Form VN075 (Rev. 07/12) PETITION FOR CERTIFICATE OF REHABILITATION AND PARDON Page 2 of 4 American LegalNet, Inc. www.FormsWorkFlow.com VN075 Thereafter, on or about _________________________________________________ , _____________ I was (date of release from actual custody) (check appropriate box): [ sentence; [ ] discharged from state prison or other state institution after completing my ] released on parole, from which I was finally discharged ______________________________________ ] released from custody on probation or after serving a jail sentence as part __________________ , __________; [ of my probation, successfully completed my probation on _______________________________________ , ________ , and obtained relief under Penal Code section 1203.4 on _______________________________________ , ________ . (If you have suffered more than three felony convictions, attach additional sheet following the same format used in paragraph 1.) II. I am now a resident of the State of California and I have continuously resided in the State of California from _______________________________________ , __________ to the present date. III. During the period of my rehabilitation, I have lived an honest and upright life, conducted myself with sobriety and Industry, and exhibited good moral character; I have conformed to and obeyed all the laws of the land. WHEREFORE, Your petitioner prays that the Court make its order and decree declaring that the petitioner has been rehabilitated, and for a Certificate of Rehabilitation recommending that the Governor of the State of California grant petitioner a full pardon; and that for such purpose a time be appointed for the hearing of the foregoing petition, and that all other and necessary proper orders may be made in the premises. DATED _____________________________ , ___________ (SIGN YOUR NAME HERE) _________________________________________ (Petitioner) _________________________________________ (Residence address) _________________________________________ Optional Form VN075 (Rev. 07/12) PETITION FOR CERTIFICATE OF REHABILITATION AND PARDON Page 3 of 4 American LegalNet, Inc. www.FormsWorkFlow.com VN075 INSTRUCTIONS (a) Prepare this