Amador — CRIM-502.3

Source: https://amador.courts.ca.gov/system/files/crim-5023_pos_certificateofrehabilitation.pdf

ATTORNEY OR PARTY WITHOUT ATTORNEY (Name & Address): FOR COURT USE ONLY

Telephone No.: Fax No. (Optional): E-Mail Address (Optional): ATTORNEY FOR (Name): Bar No: 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

CASE NUMBER: PROOF OF SERVICE

Petition for Certificate of Rehabilitation and Pardon

TO BE COMPLETED BY THE PERSON SERVING.
THE PERSON SERVING MUST NOT BE THE PETITIONER.
(This is a two-page form - Complete both pages)

Check all applicable boxes:

I am over the age of 18 years and am not a party to the within action. My Name My Address My Address

I served a copy of the Notice of Filing of Petition for Certificate of Rehabilitation and Pardon, the Petition for Certificate of Rehabilitation and Pardon and any attachments thereto on the:

GOVERNOR OF THE STATE OF CALIFORNIA DEPARTMENT OF LEGAL AFFAIRS STATE CAPITOL BUILDING 1303 10TH ST SACRAMENTO CA 95814-4910

By Personal Service: On _________________ (date), I personally delivered a copy of the Notice, Petition and attachments to the address above. The name of the person who received the copies is _______________________________________________________________ OR

By Mail: On _________________ (date), I personally mailed a copy of the Notice, Petition and attachments to the address above, by placing it in a sealed envelope with postage thereon fully prepaid into the United States mail at _________________ (place of mailing).

PROOF OF SERVICE

PETITION FOR REHABILITATION AND PARDON

Optional Use Penal Code, §§ 4852.01 CRIM-502.3 (06/12/2019) and 4852.06

Name: Case Number:

I served a copy of the Notice of Filing of Petition for Certificate of Rehabilitation and Pardon, the
Petition for Certificate of Rehabilitation and Pardon and any attachments thereto on the:

AMADOR COUNTY DISTRICT ATTORNEY
708 Court Street
Jackson, CA 95642

By Personal Service:
On _________________ (date), I personally delivered a copy of the Notice, Petition and
attachments to the address above. The name of the person who received the copies is
___________________________.
OR

By Mail:
On _________________ (date), I personally mailed a copy of the Notice, Petition and
attachments to the address above, by placing it in a sealed envelope with postage thereon
fully prepaid into the United States mail at _________________ (place of mailing).

I served a copy of the Notice of Filing of Petition for Certificate of Rehabilitation and Pardon, the
Petition for Certificate of Rehabilitation and Pardon and any attachments thereto on the:

____________________ COUNTY DISTRICT ATTORNEY
(ADDRESS) _____________________________________
(ADDRESS) _____________________________________

By Personal Service:
On _________________ (date), I personally delivered a copy of the Notice, Petition and
attachments to the address above. The name of the person who received the copies is
___________________________.
OR

By Mail:
On _________________ (date), I personally mailed a copy of the Notice, Petition and
attachments to the address above, by placing it in a sealed envelope with postage thereon
fully prepaid into the United States mail at _________________ (place of mailing).

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 OF PERSON WHO SERVED THE PAPERS) (SIGNATURE OF PERSON SERVING)

PROOF OF SERVICE

PETITION FOR REHABILITATION AND PARDON

Optional Use Penal Code, §§ 4852.01 CRIM-502.3 (06/12/2019) and 4852.06