Amador — CRIM-502.4

Source: https://amador.courts.ca.gov/system/files/crim-5024_certificateofrehabilitation.pdf

For Court Use Only SUPERIOR COURT OF CALIFORNIA, COUNTY OF AMADOR 500 ARGONAUT LANE Jackson, CA 95642

In the Matter of the Application of

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Petitioner’s full name – First Middle Last and Suffix, if applicable

Date of Birth:

CII Number:

Criminal Case Number(s): ____________________________________________

CERTIFICATE OF REHABILITATION CERTIFICATE NUMBER:
(Penal Code § 4852.13)

The petition of , presently residing
Type Applicant’s Full Name - First Middle Last and Suffix, if applicable

at , requesting a Type Applicant's Street Address, City, State, and ZIP Code

a Certificate of Rehabilitation pursuant to the provisions of Chapter 3.5, Title 6 of Part 3 of the Penal Code

of the State of California, was heard on Date

and proof having been made to the satisfaction of the Court that notice of the time of hearing has been regularly given as

required by law; and from satisfactory proof taken at said hearing the Court finds that all allegations of said petition are true,

and that the required period of rehabilitation has elapsed since petitioner's date of discharge from custody due to completion of

the term to which the petitioner was sentenced, or upon the release on parole or probation on

, that, where appropriate, petitioner has obtained relief pursuant to Penal

Month Day, Year

Penal Code section 1203.4, and that petitioner has demonstrated by the course of conduct his/her rehabilitation and fitness to

exercise all the civil and political rights of citizenship (except as provided in Penal Code section 4852.15); and that the

that petitioner has been time(s) convicted of a felony; Total Number of Felony Convictions

The Certificate of Rehabilitation is granted. This Court declares the petitioner has been rehabilitated and is fit to exercise all the civil and political rights of citizenship (except as provided in Penal Code section 4852.15), and this Court recommends that the Governor of the State of California grant a full pardon to said petitioner.

Dated:

Judicial Officer - TYPED or PRINTED Judicial Officer - SIGNATURE

This form was prepared under the direction of the Office of the Attorney General of the State of California

CERTIFICATE OF REHABILIATION

Optional Use Penal Code § 4852.13 CRIM-502.4 (06/12/2019)