Packet For Certificate For Rehabilitation Or Pardon (Petition For Certificate Of Rehabilitation) {1}

IN THE SUPERIOR COURT OF THE STATE OF CALIFORNIA IN AND FOR THE COUNTY OF Applicant's County of Residence In the Matter of the Application of Court use only Type Applicant's Full Name - First Middle Last and Suffix, if applicable Date of Birth CII Number Criminal Case Number(s) List applicable Criminal Case Number(s) Month Day, Year PETITION FOR CERTIFICATE OF REHABILITATION AND PARDON Pursuant to Penal Code Sections 4852.01 and 4852.06 The above-named applicant hereby respectfully represents and shows that: FELONY HISTORY [ All felony convictions must be listed. If you have suffered more than three (3) felony convictions, attach additional sheets following the same format. ] Most Recent Felony Conviction On or about Month Day, Year , I was convicted of the crime of Indicate crime and Penal Code Section , in the county of , California. My sentence for this offense was: [ Check appropriate box ] Commitment to state prison or other state institution at Name of institution or city where located ; Probation with suspended sentence to state prison or other state institution; Probation, after the sentencing proceedings were suspended. Thereafter, on or about Date released from custody , I was; [ 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 Discharge date ; Released from custody on probation after serving a jail sentence; As a condition of my probation, I was released from custody after serving time in jail, and successfully completed my probation on Date probation ended , and obtained relief under Penal Code . Date 1203.4 granted by the Court section 1203.4 on FORM 1 (Revised 1/21/98) This form was prepared by the Investigations Division of the Board of Prison Terms pursuant to Penal Code Section 4852.18. American LegalNet, Inc. www.FormsWorkFlow.com Second Most Recent Felony Conviction On or about Month Day, Year , I was convicted of the crime of Indicate crime and Penal Code Section , in the county of , California. My sentence for this offense was: [ Check appropriate box ] Commitment to state prison or other state institution at Name of institution or city where located ; Probation with suspended sentence to state prison or other state institution; Probation, after the sentencing proceedings were suspended. Thereafter, on or about Date released from custody , I was; [ 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 Discharge date ; Released from custody on probation after serving a jail sentence; As a condition of my probation, I was released from custody after serving time in jail, and successfully completed my probation on Date probation ended , and obtained relief under Penal Code . Date 1203.4 granted by the Court section 1203.4 on Third Most Recent Felony Conviction On or about Month Day, Year , I was convicted of the crime of Indicate crime and Penal Code Section , in the county of , California. My sentence for this offense was: [ Check appropriate box ] Commitment to state prison or other state institution at Name of institution or city where located ; Probation with suspended sentence to state prison or other state institution; Probation, after the sentencing proceedings were suspended. Thereafter, on or about Date released from custody , I was; [ 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 Discharge date ; Released from custody on probation after serving a jail sentence; As a condition of my probation, I was released from custody after serving time in jail, and successfully completed my probation on Date probation ended , and obtained relief under Penal Code . Date 1203.4 granted by the Court section 1203.4 on FORM 1 (Revised 1/21/98) This form was prepared by the Investigations Division of the Board of Prison Terms pursuant to Penal Code Section 4852.18. American LegalNet, Inc. www.FormsWorkFlow.com RESIDENCY HISTORY I am now a resident of the State of California, and I have continuously resided in the State of California from Month Day, Year , to the present date. APPLICANT'S DECLARATION 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 other and necessary proper orders may be made in the premises. Applicant's Signature Month Day, Year Applicant's Street Address Applicant's City, State ZIP Code FORM 1 (Revised 1/21/98) This form was prepared by the Investigations Division of the Board of Prison Terms pursuant to Penal Code Section 4852.18. American LegalNet, Inc. www.FormsWorkFlow.com