Petition Penal Form – Fill Out and Use This PDF

ATTORNEY OR PARTY WITHOUT ATTORNEY (Name, Address, Telephone No.)

FOR COURT USE ONLY

ATTORNEY FOR (Name) :

SUPERIOR COURT OF CALIFORNIA, COUNTY OF ORANGE

JUSTICE CENTER:

£Central - 700 Civic Center Dr. West, Santa Ana, CA 92701

£Harbor-Newport Beach - 4601 Jamboree Rd., Newport Beach, CA 92660-2595

£Harbor-Laguna Niguel - 30143 Crown Valley Pkwy., Laguna Niguel, CA 92677

£Harbor- Laguna Hills - 23141 Moulton Parkway 2nd Floor, Laguna Hills, CA 92563-1206

£North - 1275 N. Berkeley Ave., P. O. Box 5000, Fullerton, CA 92838-0500

£West - 8141 13th Street, Westminster, CA 92683

PEOPLE OF THE STATE OF CALIFORNIA

VS.
Defendant:__________________________________________
	Case Number:
PETITION FOR RELIEF UNDER PENAL CODE §1203.4, §1203.4a	Driver’s License Number:
	Date of Birth:

1.I am the c Defendant c Attorney for the defendant c Probation Officer for the defendant in the above-entitled action.

2.On the date of _________________, the defendant was convicted of the misdemeanor/felony offense of violation of section(s) (list all):

____________________________________________________________________________________________

3.Petitioner declares:

c The defendant has fulfilled the conditions of probation for the entire period of probation or has been discharged prior to termination of the period of probation; that the defendant is not serving a sentence for any offense, on probation for any offense, or charged with the commission of any offense. (Penal Code §1203.4)

c The defendant was not placed on probation; that more than one year has elapsed since the date of pronouncement of judgment; that the defendant has complied with the sentence of the court; that the defendant is not serving a sentence for any offense nor under charge of commission of any crime, and has since pronouncement of judgment lived an honest and upright life, and conformed to and obeyed the laws of the land. (Penal Code §1203.4a)

4.Petitioner and defendant understand that the granting of this petition does NOT relieve the defendant of the obligation to disclose the conviction in response to any direct question contained in any questionnaire or application for public office, for licensure by any state or local agency, or for contracting with the California State Lottery, does NOT affect DMV actions or further consequences for crimes involving the operation of a motor vehicle, does NOT permit the defendant to own, possess or have in their custody or control any concealable firearm. The granting of this petition does NOT seal your record. The case, including the conviction will remain public record. The granting of the petition does NOT relieve the defendant of any obligation to register under Penal Code 290.

5.Petitioner and defendant request the conviction be set aside, that a plea of not guilty be entered, and that the Court dismiss this action pursuant to the provisions of Penal Code §1203.4, §1203.4a.

6.Petitioner and defendant have the right to have the Court determine the defendant’s ability to pay the reimbursement costs by personally submitting the Defendant’s Financial Statement pursuant to the standards set forth in Penal Code 987.8(g)(2). If reimbursement costs are submitted with this petition, defendant waives the right to the judicial determination of ability to pay.

7.I declare under penalty of perjury under the laws of the State of California that the foregoing is true and correct. Date:____________________

__________________________________	____________________________________________
(Type or print name)	(Signature of Petitioner)

PETITION FOR RELIEF UNDER PENAL CODE §1203.4, §1203.4a

	Form # 1073
	(Rev. August 14, 2003)	Penal Code §1203.4, 1203.4a
	Optional Form
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