California Certificate Rehabilitation – Fill Out and Use This PDF

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

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 Convictions

[ Check all that apply ]

☐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.

Date released from custody

☐Discharged from state prison or other state institution after completing my sentence;

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

FORM 1 (Revised 10/25/2019)This form was prepared by the Board of Parole Hearings pursuant to Penal Code Section 4852.18.

Second Most Recent Felony Convictions

[ Check all that apply ]

☐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.

Date released from custody

☐Discharged from state prison or other state institution after completing my sentence;

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

Third Most Recent Felony Conviction

[ Check all that apply ]

☐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.

Date released from custody

☐Discharged from state prison or other state institution after completing my sentence;

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

FORM 1 (Revised 10/25/2019)This form was prepared by the Board of Parole Hearings pursuant to Penal Code Section 4852.18.

RESIDENCY HISTORY

I am now a resident of the State of California, and I have continuously resided in the State of California

Month Day, Year

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.(Pen. Code, § 4852.05.)

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 Street Address

Applicant’s City, State and ZIP Code

Applicant’s Driver License Number

Applicant’s Email Address

Applicant’s Home Phone Number

Applicant’s Work Phone Number

Applicant’s Cell Phone Number

FORM 1 (Revised 10/25/2019)This form was prepared by the Board of Parole Hearings pursuant to Penal Code Section 4852.18.

FORM 1 INSTRUCTIONS

1.Obtain Your Criminal Records

To complete this form, you will need information regarding each of your felony convictions, including the date of each conviction, the specific charge or charges for which you were convicted, the county of the conviction, and the sentence that was given. In addition, you will need to know the date that you were released from prison or jail and/or discharged from parole or probation.

This information may be obtained through the court in which the conviction(s) took place, or you may obtain a copy of your state criminal record through the California Department of Justice. You may only obtain your own records from the Department of Justice. Information regarding this request may

be obtained through the Office of the Attorney General website at https://oag.ca.gov/fingerprints/record-review. Regardless of the number of convictions, you will be filing only a single petition.

2.Confirm Your Eligibility

You are ineligible for a certificate of rehabilitation if any of the following are true:

You were convicted only of misdemeanors (other than sex offenses defined in Penal Code section 290, which were subsequently expunged) (Pen. Code, §4852.01, (b).)

You were convicted of specific sex crimes involving minor children as enumerated under Penal Code sections 286, subdivision (c), 288, 288a, subdivision (c), 288.5, and 289, subdivision (j). (Pen. Code, § 4852.01, (c).)

You are serving mandatory life parole. (Pen. Code, § 4852.01, (c).)

You were sent to state prison under a death sentence. (Pen. Code, § 4852.01, (c).)

You are currently in military service. (Pen. Code, § 4852.01, (c).)

Minimum Period of Rehabilitation

In order to be granted a certificate of rehabilitation you must satisfy a minimum period of rehabilitation. In every case, you must have resided continuously for five years in this state prior to filing the petition. (Pen. Code, § 4852.06) The period of rehabilitation begins to run upon your discharge from custody or upon release on parole or probation, whichever is sooner. (Pen. Code, § 4852.03, (a).) The period of rehabilitation shall constitute five years residence in this state, plus a period of time determined by the following rules:

An additional four years in the case of any person convicted of violating Section 187 (murder), 209 (aggravated kidnapping), 219 (derailing or wrecking a train), 4500 (assault with force likely to cause great bodily injury), or 12310 (use of explosives or destructive devices causing death, mayhem, or great bodily injury) of the Penal Code, or subdivision

(a)of Section 1672 of the Military and Veterans Code (acting or failing to act so as to cause another person’s death), or any other offense which carries a life sentence. (Pen. Code, § 4852.03, (a)(1).)

An additional five years in the case of any person convicted of any offense or attempted offense for which sex offender registration is required pursuant to Penal Code 290, except for convictions for violations of subdivision (b), (c), or (d) of Section 311.2 (possession or distribution of media depicting a minor engaging in sexual conduct), or of Section 311.3 (sexual exploitation of a child), 311.10 (advertising obscene matter depicting a minor engaging in sexual conduct), or 314 (indecent exposure). For those convictions, two years shall be added to the five years imposed by this section. (Pen. Code, § 4852.03, (a)(2).)

FORM 1 (Revised 10/25/2019)This form was prepared by the Board of Parole Hearings pursuant to Penal Code Section 4852.18.

An additional two years in the case of any person convicted of committing any offense not listed above and which does not carry a life sentence. (Pen. Code, §4852.03, (a)(3).)

Additionally, the trial court hearing your application for a certificate of rehabilitation may add additional years if you served consecutive sentences. The amount of additional time will not exceed the sum of the maximum penalties for all your crimes. (Pen. Code, § 4852.03, (a)(4).)

Felony Probation

If you were released on felony probation and successfully completed probation, you must obtain relief under Penal Code Section 1203.4 before applying for a Certificate of Rehabilitation.

3.File Your Documents

After completing the Petition for Certificate of Rehabilitation and Pardon, you must file it with the superior court in the county of conviction or in your county of residency. (Pen. Code, § 4852.06.)

You are entitled to be represented by an attorney of your own selection, or by the public defender. (Pen. Code, § 4852.08.)

You are entitled to receive assistance from all rehabilitative agencies including officers from adult probation and parole, and for persons under the age of 30 years, from the Division of Juvenile Facilities. (Pen. Code, § 4852.04)

It is unlawful for anyone, other than an attorney, to accept any fee, money or anything of value for their services in representing you in this proceeding. (Pen. Code, § 4852.2.)

You are not required to pay filing fees of any kind in connection with this proceeding. (Pen. Code, § 4852.09.)

4.Notice of Filing

When the court sets a hearing date on your petition, you are required to give notice of that date at least 30 days before the hearing. You must formally notify the District Attorney for each county in which you have been convicted, the county in which the petition is filed, and the Governor's Office. (Pen. Code, § 4852.07.) For more information on the notice requirements, please reference the

Notice of Filing of Petition for Certificate of Rehabilitation and Pardon.

5.After a Certificate of Rehabilitation is Issued

A certificate of rehabilitation is not an automatic pardon; it is only an automatic application for a pardon. In the event that a certificate of rehabilitation is issued by a court, the certificate of rehabilitation shall be reviewed by the Board of Parole Hearings within one year. Thereafter, the Board shall issue a recommendation as to whether the Governor should pardon that individual. (Pen. Code, § 4852.16, (b).)

FORM 1 (Revised 10/25/2019)This form was prepared by the Board of Parole Hearings pursuant to Penal Code Section 4852.18.