Orange — Certificate of Rehabilitation and Pardon

Source: https://www.occourts.org/system/files/selfhelp/shc-crim-07.pdf

SUPERIOR COURT OF CALIFORNIA Self-Help Services COUNTY OF ORANGE www.occourts.org/self-help

CERTIFICATE OF REHABILITATION AND PARDON

SELF-HELP FORM PACKET

SHC-CRIM-07 (Rev. 08/07/2025)

www.occourts.org/self-help

SUPERIOR COURT OF CALIFORNIA COUNTY OF ORANGE 700 Civic Center Drive West Santa Ana, CA 92702-2024 (657) 622-8459 www.occourts.org

CERTIFICATE OF REHABILITATION AND PARDON
Information
Penal Code 4852.01, and 4852.06

• Instruction Sheet
• Petition for Certificate of Rehabilitation and Pardon
• Notice of Filing of Petition for Certificate of Rehabilitation and Pardon
• Proof of Service
• Certificate of Rehabilitation

Optional Use Penal Code 4852.01, et seq. Form #: L-0799 Revised: August 5, 2016

SUPERIOR COURT OF CALIFORNIA, COUNTY OF ORANGE 700 Civic Center Drive West P.O. Box 22024 Santa Ana, CA 92702-2024 (657) 622-8459 www.occourts.org

Petition for Certificate of Rehabilitation and Pardon Instructions

These are the instructions for completing the Orange County Superior Court forms entitled “Petition for Certificate of Rehabilitation and Pardon” (Form No. L-0408.1), “Notice of Filing Petition for Certificate of Rehabilitation and Pardon” (Form No. L-0409), “Proof of Service- Petition for Certificate of Rehabilitation and Pardon” (Form No.L-0801), and the “Certificate of Rehabilitation” (Form No. L-410.2).

The petition must be filed in the Superior Court of the county in which the petitioner currently resides. If the Court grants the petition, the certificate of rehabilitation will be transmitted to the Governor and will constitute an application for a full pardon. (Penal Code § 4852.16)

Only one petition should be filed, even if the petitioner has multiple convictions. All felony convictions and convictions of misdemeanor sex offenses specified in Penal Code section 290 must be disclosed in the petition.

Section 1 - Are You Eligible?

If you were convicted of a felony and committed to a state prison, institution, or agency

including commitment to a county jail pursuant to subdivision (h) of Section 1170, you may file a petition for a certificate of rehabilitation and pardon if you can demonstrate the following: (1) After leaving prison or other institution or agency, you have resided continuously in California for the five years immediately preceding the filing of this petition; (2) You have completed the applicable rehabilitation period set forth below in Section 2 of these instructions; and (3) You have lived an honest and upright life, conducted yourself with sobriety and industry, exhibited a good moral character, and conformed to and obeyed the laws of the land since being released. (Penal Code §§ 4852.01(a); 4852.01(b); 4852.03; 4852.05; 4852.06)

If you were convicted of a felony sex offense specified in Penal Code section 290, and

you were sentenced pursuant to Penal Code section 1170(h), you may file a petition for certificate of rehabilitation and pardon if you meet all of the following requirements: (1) You have obtained relief under Penal Code section 1203.41; (2) You have not been incarcerated in any prison, jail, detention facility, or other penal institution or agency after your Penal Code section 1203.41 petition was granted; (3) You are not currently on probation or mandatory supervision for any other felony; (4) You present satisfactory evidence of five years continuous residence in this state immediately prior to the filing of this petition; (5) You have completed the applicable rehabilitation period set forth below in Section 2 of these instructions; and (6) You have lived an honest and upright life, conducted yourself with sobriety and industry, exhibited a good moral character, and conformed to and obeyed the laws of the land since being released. (Penal Code §§ 4852.01(b); 4852.03; 4852.05; 4852.06)

If you were convicted of a felony or a misdemeanor sex offense specified in Penal Code

section 290, and you were placed on probation, you may file a petition for certificate of rehabilitation and pardon if you meet all of the following requirements: (1) You have obtained relief under Penal Code section 1203.4; (2) You have not been incarcerated in

PETITION FOR CERTIFICATE OF REHABILITATION AND PARDON

Optional Use INSTRUCTIONS Pen. Code §4852.01, et seq. Form #: L-0800 [Revised December 19, 2024]

SUPERIOR COURT OF CALIFORNIA, COUNTY OF ORANGE 700 Civic Center Drive West P.O. Box 22024 Santa Ana, CA 92702-2024 (657) 622-8459 www.occourts.org

Petition for Certificate of Rehabilitation and Pardon Instructions

any prison, jail, detention facility, or other penal institution or agency after your Penal Code Section 1203.4 petition was granted; (3) You are not currently on probation or mandatory supervision for any other felony; (4) You present satisfactory evidence of five years continuous residence in this state immediately prior to the filing of this petition; (5) You have completed the applicable rehabilitation period set forth below in Section 2 of these instructions; and (6) You have lived an honest and upright life, conducted yourself with sobriety and industry, exhibited a good moral character, and conformed to and obeyed the laws of the land since being released. (Penal Code §§ 4852.01(b); 4852.03; 4852.05; 4852.06)

You are not eligible to apply for a certificate of rehabilitation and pardon if any of the following are true: (1) You are serving a mandatory life parole; (2) You were committed under a death sentence; (3) You were convicted of any of the following: Penal Code section 269; Penal Code section 286, subdivision (c); Penal Code section 288; Penal Code section 288a, subdivision (c); Penal Code section 288.5; Penal Code Section 288.7; or Penal Code section 289, subdivision (j); (4) You are in the military service. (Penal Code § 4852.01(d)).

Section 2 - When Can You File?

You may file for a certificate of rehabilitation and pardon after your period of
rehabilitation ends. The period of rehabilitation begins when you are either discharged
from custody after completing the term to which you were sentenced, or upon your
release on parole or probation, whichever occurs first. (Penal Code § 4852.03(a)) The
period of rehabilitation consists of five years of residence in this state plus one of the
following applicable periods:

1) Four years will be added if you were convicted of violating Penal Code
sections 187, 209, 219, 4500, or 18755, or Military and Veterans Code
Section 1672, subdivision (a), or of committing any other offense which
carries a life sentence, making the rehabilitation period a total of nine
years. (Penal Code § 4852.03(a)(1)).

2) Five years will be added if you were convicted of committing any offense
or attempted offense for which sex offender registration is required,
making the rehabilitation period a total of ten years (Penal Code § 290).
However, if you were convicted of violating Penal Code section 311.2,
subdivision (b),(c) or (d), or Penal Code sections 311.3, 311.10, or 314,
only two years will be added to the five years of residency, making it a total
of seven years. (Penal Code § 4852.03(a)(2)).

3) Two years will be added if you were convicted of any offense that is not
listed in paragraphs 1) or 2) above, making the rehabilitation period a
total of seven years. (Penal Code §4852.03(a)(3)).

PETITION FOR CERTIFICATE OF REHABILITATION AND PARDON

Optional Use INSTRUCTIONS Pen. Code §4852.01, et seq. Form #: L-0800 [Revised December 19, 2024]

SUPERIOR COURT OF CALIFORNIA, COUNTY OF ORANGE 700 Civic Center Drive West P.O. Box 22024 Santa Ana, CA 92702-2024 (657) 622-8459 www.occourts.org

Petition for Certificate of Rehabilitation and Pardon Instructions

Section 3 - Can You Receive Assistance?

If you are eligible to file the petition, you are entitled to receive assistance from all

rehabilitative agencies including the adult probation officer of the county, all state parole officers, and the youth authority (for those under the age of 30). (Penal Code § 4852.04) You may be represented by an attorney of your own selection, or if you have no such counsel, then by the public defender. (Penal Code § 4852.08)

Other than an attorney licensed to practice law in California, it is a misdemeanor for any person to solicit or accept any money, fee (or anything of value) for representing you in connection with your petition for certificate of rehabilitation or in an application for a pardon. (Penal Code § 4852.2).

There are no filing fees or court fees to obtain a certificate of rehabilitation and pardon. (Penal Code § 4852.09).

Section 4 - How Do You File the Documents and Notify the Proper Entities?

PREPARING THE PETITION AND RELATED DOCUMENTS:

A. You must completely fill out the petition (Form No.L-0408.1), sign it, and file it with the Clerk of the Court. When filling out this petition, you must list all California convictions for felony offenses and for misdemeanor sex offenses which are specified in Penal Code section 290.

Because the petition for rehabilitation must list all the foregoing convictions, you should file only one petition, regardless of the number of convictions you have sustained. If the Court determines that you are rehabilitated, the certificate of rehabilitation will apply to all convictions listed on your petition. If you have failed to list all required offenses, then even if your petition is granted by the Court, the Governor’s Legal Affairs Office will not proceed to the next step in your application for a pardon.

If you received a Penal Code section 1203.4 dismissal, attach a copy of the dismissal

order to the petition.

B. You must also completely fill out and sign the Notice (Form No. L-0409). Before serving the documents, you must fill in the hearing date and time. You may either select it yourself on a Friday at least 45 days away, at 8:30 a.m., or you may obtain the hearing date/time from the clerk’s office. Although these matters are currently heard in Department C5, at the Central Justice Center, it is a good idea to check with the clerk as to the correct department (courtroom) before completing the Notice form.

C. In addition, you must fill out the Certificate of Rehabilitation (Form No. L-0410.2), but do not sign it. If your petition is granted, the Certificate will be signed by the judge at the time the petition is granted.

D. The Proof of Service (Form No. L-0801), must be filled out by the person who has served the documents, which must be someone other than the petitioner. (See below.)

PETITION FOR CERTIFICATE OF REHABILITATION AND PARDON

Optional Use INSTRUCTIONS Pen. Code §4852.01, et seq. Form #: L-0800 [Revised December 19, 2024]

SUPERIOR COURT OF CALIFORNIA, COUNTY OF ORANGE 700 Civic Center Drive West P.O. Box 22024 Santa Ana, CA 92702-2024 (657) 622-8459 www.occourts.org

Petition for Certificate of Rehabilitation and Pardon Instructions

SERVING (NOTIFYING) THE PROPER ENTITIES:

Thirty (30) days written notice of the hearing date and time on your petition must be given to: (1) the district attorney of the county in which you filed the petition; and (2) the district attorney of each county in which you were convicted of a felony or of an offense that was dismissed pursuant to Penal Code § 1203.4 (Penal Code § 4852.07).

To accomplish this, you will need at least four copies of the following forms: the Petition, the Notice, the Proof of Service and the Certificate of Rehabilitation (Forms L-0408.1, L- 0409, L-0801, and L-410.2):

The original is for the Court; One copy is for petitioner’s records; One copy is for the Orange County District Attorney; One copy is for each District Attorney of any other county in which the petitioner was convicted.

The Orange County District Attorney and the District Attorney of each county of conviction must be “served.” “Served” means to be formally provided with notice of the proceedings and copies of all relevant documents. These documents may be “served” either by mail or in person.

The person serving the above-referenced documents must be over the age of 18 years and MAY NOT BE THE PETITIONER. The person who serves the documents must also complete and sign the Proof of Service.

PETITION FOR CERTIFICATE OF REHABILITATION AND PARDON

Optional Use INSTRUCTIONS Pen. Code §4852.01, et seq. Form #: L-0800 [Revised December 19, 2024]

SUPERIOR COURT OF CALIFORNIA, COUNTY OF ORANGE 700 Civic Center Drive West P.O. Box 22024 Santa Ana, CA 92702-2024 (657) 622-8459 www.occourts.org

Petition for Certificate of Rehabilitation and Pardon Instructions

The above-referenced documents must be served on the following:

ORANGE COUNTY DISTRICT ATTORNEY 401 Civic Center Drive West Santa Ana, CA 92701

District Attorney of any other county where the petitioner was convicted

Personal service must be completed at least 30 days prior to the hearing date. Service by mail must be completed at least 35 days prior to the hearing date.

FILING THE DOCUMENTS WITH THE COURT CLERK:

After service is made, take all the documents (the Petition, the Notice, the Certificate and the Proof of Service) to the Criminal Clerks Office at Central Justice Center in room L-100 and submit them to the court clerk for filing.

Section 5 – The Hearing and Disposition

On the hearing date, the petitioner or their attorney must appear in court in the appropriate department at the designated time. Because many other cases may be calendared for the same date, a long wait is not uncommon.

Please be aware that if the Court grants the petition and signs the Certificate of Rehabilitation, this does not constitute a pardon. If the Court grants the petition, the Criminal Clerks’ Office will send a certified copy of the Certificate of Rehabilitation to the Governor. The certified copy of the Certificate becomes an application to the Governor for a full pardon. The Governor will decide whether or not to issue the pardon.

PETITION FOR CERTIFICATE OF REHABILITATION AND PARDON

Optional Use INSTRUCTIONS Pen. Code §4852.01, et seq. Form #: L-0800 [Revised December 19, 2024]

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 ORANGE CENTRAL JUSTICE CENTER 700 CIVIC CENTER DRIVE WEST POST OFFICE BOX 22024 SANTA ANA, CA 92702-2024

In the Matter of the Application of

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

Date of Birth:
CII Number:
Criminal Case Number(s):

PETITION FOR CERTIFICATE OF REHABILITATION AND PARDON CASE NUMBER:
(Penal Code 4852.01 et seq.) M -

To the Superior Court of California, County of Orange:

The above-named petitioner represents and shows that:

CONVICTION HISTORY

[All qualifying convictions must be listed. If you have more than three (3) qualifying convictions, attach additional sheets following the same format.] Most Recent Qualifying Conviction

(A)

Offense

On or about , petitioner was convicted of the crime of Month Day, Year Indicate Crime and Code Section

on case number: in the County of , California.

(B)

Type of Sentence or Disposition

Petitioner’s sentence for this offense was: [Check the appropriate box]

Commitment to state prison or other state institution at ;
Name of institution or city where located

Sentenced to county jail pursuant to Penal Code 1170(h) at ;
Name of county where located

Sentenced to state prison, but execution of sentence was suspended and petitioner was placed on probation.

Imposition of sentence was suspended and petitioner was placed on probation.

L-0408 Petition for Certificate of Rehabilitation and Pardon Penal Code 4852.01 Revised: 12/31/2015 Page 1 of 7

Name: Case Number: M-

(C)

Date of Release

Thereafter, on or about , petitioner was; Date released from custody

[Check the appropriate box(es)]

Discharged from state prison or other state institution after completing his/her sentence on (date).

Released on parole on (date).

Released from county jail pursuant to Penal Code 1170(h) (no mandatory supervision) on (date).

Released from county jail to serve mandatory supervision pursuant to Penal Code 1170(h) on (date).

Released from custody on probation (after serving a jail sentence as a condition of probation) on (date).

Released on probation (if no jail sentence was imposed) on (date).

(D)
Penal Code 1203.4 History (For Probationers Only)
A. After termination of probation on , a petition for relief under Penal Code section 1203.4 was
granted on (date).

B. Has petitioner been incarcerated in any prison, jail, detention facility, or other penal institution or agency after
his/her Penal Code section 1203.4 petition was granted? Yes No

C. If yes, when and where? .

D. Is petitioner currently on probation or mandatory supervision for the commission of any other felony? Yes No

E. Petitioner presents the following evidence that he/she has resided in California for the past five years (supporting
documentation may be attached as exhibits to the petition):

(E)
Penal Code 1203.41 History (For sentences pursuant to PC 1170(h) only)

a) A petition for relief under Penal Code section 1203.41 was granted on __________________(date).

b) Has petitioner been incarcerated in any prison, jail, detention facility, or other penal institution or agency after his/her
Penal Code section 1203.41 petition was granted? Yes _____ No_____

c) If yes, when and where? _______________________________.

d) Is petitioner currently on probation for the commission of any other felony? Yes_____ No_____

e) Petitioner presents the following evidence that he/she has resided in California for the past five years (supporting
documentation may be attached as exhibits to the petition):

L-0408 Petition for Certificate of Rehabilitation and Pardon Penal Code 4852.01 Revised: 12/31/2015 Page 2 of 7

Name: Case Number: M-

Second Most Recent Qualifying Conviction

(A)

Offense

On or about , petitioner was convicted of the crime of Month Day, Year Indicate Crime and Code Section

on case number: in the County of , California.

(B)

Type of Sentence or Disposition

Petitioner’s sentence for this offense was: [Check the appropriate box]

Commitment to state prison or other state institution at ;
Name of institution or city where located

Sentenced to county jail pursuant to Penal Code 1170(h) at ;
Name of county where located

Sentenced to state prison, but execution of sentence was suspended and petitioner was placed on probation.

Imposition of sentence was suspended and petitioner was placed on probation.

(C)
Date of Release

Thereafter, on or about , petitioner was; Date released from custody

[Check the appropriate box(es)]

Discharged from state prison or other state institution after completing his/her sentence on (date).

Released on parole on (date).

Released from county jail pursuant to Penal Code 1170(h) (no mandatory supervision) on ________(date;

Released from county jail to serve mandatory supervision pursuant to Penal Code 1170(h) on ________(date;

Released from custody on probation (after serving a jail sentence as a condition of probation)

on (date).

Released on probation (if no jail sentence was imposed) on (date).

(D)
Penal Code 1203.4 History (For Probationers Only)
A. After termination of probation on _, a petition for relief under Penal Code section 1203.4 was
granted on (date).

B. Has petitioner been incarcerated in any prison, jail, detention facility, or other penal institution or agency after
his/her Penal Code section 1203.4 petition was granted? Yes _ No_

C. If yes, when and where?

D. Is petitioner currently on probation or mandatory supervision for the commission of any other felony?

Yes No

E. Petitioner presents the following evidence that he/she has resided in California for the past five years (supporting
documentation may be attached as exhibits to the petition):

L-0408 Petition for Certificate of Rehabilitation and Pardon Penal Code 4852.01 Revised: 12/31/2015 Page 3 of 7

Name: Case Number: M-

(E)
Penal Code 1203.41 History (For sentences pursuant to PC 1170(h) only)

a) A petition for relief under Penal Code section 1203.41 was granted on __________________(date).

b) Has petitioner been incarcerated in any prison, jail, detention facility, or other penal institution or agency after his/her
Penal Code section 1203.41 petition was granted? Yes _____ No_____

c) If yes, when and where? _______________________________.

d) Is petitioner currently on probation for the commission of any other felony? Yes_____ No_____

e) Petitioner presents the following evidence that he/she has resided in California for the past five years (supporting
documentation may be attached as exhibits to the petition):

Third Most Recent Qualifying Conviction

(A)
Offense

On or about , petitioner was convicted of the crime of Month Day, Year Indicate Crime and Code Section

on case number: in the County of , California.

(B)

Type of Sentence or Disposition

Petitioner’s sentence for this offense was: [Check the appropriate box]

Commitment to state prison or other state institution at ;
Name of institution or city where located

Sentenced to county jail pursuant to Penal Code 1170(h) at ;
Name of county where located

Sentenced to state prison, but execution of sentence was suspended and petitioner was placed on probation.

Imposition of sentence was suspended and petitioner was placed on probation.

(C)
Date of Release

Thereafter, on or about , petitioner was; Date released from custody

[Check the appropriate box(es)]

Discharged from state prison or other state institution after completing his/her sentence on (date).

Released on parole on (date).

Released from county jail pursuant to Penal Code 1170(h) (no mandatory supervision) on _____________________(date;

Released from county jail to serve mandatory supervision pursuant to Penal Code 1170(h) on ________________(date;

Released from custody on probation (after serving a jail sentence as a condition of probation) on _____________(date).

Released on probation (if no jail sentence was imposed) on (date).

L-0408 Petition for Certificate of Rehabilitation and Pardon Penal Code 4852.01 Revised: 12/31/2015 Page 4 of 7

Name: Case Number: M-

(D)
Penal Code 1203.4 History (For Probationers Only)

A. After termination of probation on _, a petition for relief under Penal Code section 1203.4 was
granted on (date).

B. Has petitioner been incarcerated in any prison, jail, detention facility, or other penal institution or agency after
his/her Penal Code section 1203.4 petition was granted? Yes ____ No _____

C. If yes, when and where?

D. Is petitioner currently on probation or mandatory supervision for the commission of any other felony? Yes ____ No _____

E. Petitioner presents the following evidence that he/she has resided in California for the past five years (supporting
documentation may be attached as exhibits to the petition):

F.

G.

H.

(E)
Penal Code 1203.41 History (For sentences pursuant to PC 1170(h) only)

A. A petition for relief under Penal Code section 1203.41 was granted on __________________(date).

B. Has petitioner been incarcerated in any prison, jail, detention facility, or other penal institution or agency after his/her

Penal Code section 1203.41 petition was granted? Yes _____ No_____

C. If yes, when and where? _______________________________.

D. Is petitioner currently on probation for the commission of any other felony? Yes_____ No_____

E. Petitioner presents the following evidence that he/she has resided in California for the past five years (supporting

documentation may be attached as exhibits to the petition):

RESIDENCY HISTORY
I am now a resident of the State of California, and I have continuously resided in the State of California from _________________

__________________________________, to the present date.

I currently reside in the County of at the following address:

_____

L-0408 Petition for Certificate of Rehabilitation and Pardon Penal Code 4852.01 Revised: 12/31/2015 Page 5 of 7

Name: Case Number: M-

L-0408 Petition for Certificate of Rehabilitation and Pardon Penal Code 4852.01 Revised: 12/31/2015 Page 6 of 7

Name: Case Number: M-

PETITIONER’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.

I request that the Court make its order declaring that I have been rehabilitated; and for a Certificate of

Rehabilitation recommending that the Governor of the State of California grant me a full pardon.

I declare under penalty of perjury under the laws of the State of California that the foregoing information is true

and correct.

Date SIGNATURE OF PETITIONER

TYPE OR PRINT NAME OF PETITIONER

L-0408 Petition for Certificate of Rehabilitation and Pardon Penal Code 4852.01 Revised: 12/31/2015 Page 7 of 7

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 ORANGE CENTRAL JUSTICE CENTER 700 CIVIC CENTER DRIVE WEST POST OFFICE BOX 22024 SANTA ANA, CA 92702-2024

In the Matter of the Application of

---

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

Date of Birth: CII Number:

NOTICE OF FILING OF PETITION FOR CERTIFICATE OF REHABILITATION CASE NUMBER: AND PARDON M - (Penal Code § 4852.07)

To the Governor of the State of California:

To the District Attorney, County of ; County of Petitioner’s Residence

To the District Attorney, County of ; County of most recent qualifying conviction, if different from County of Residence

To the District Attorney, County of ; County of 2nd most recent qualifying conviction, if applicable

To the District Attorney, County of ; County of 3rd most recent qualifying conviction, if applicable

On _________________________ the undersigned has filed a petition in the above mentioned court for a Date of Filing

Certificate of Rehabilitation and Pardon in accordance with the provision of Chapter 3.5, Title 6, Part 3 of the Penal

Code of the State of California.

The petition will be heard on _______________ at ___________ in Department __________ at the Superior Court Date of Hearing Time Department

of California, County of Orange, Central Justice Center.

Date SIGNATURE OF PETITIONER

TYPE OR PRINT NAME OF PETITIONER

Petitioner’s Address:

City, State, ZIP

NOTICE OF FILING OF PETITION FOR CERTIFICATE OF REHABILIATION AND PARDON

Optional Use Penal Code, §§ 4852.07 Form: L-409 [Rev.July 15, 2011]

For Court Use Only SUPERIOR COURT OF CALIFORNIA, COUNTY OF ORANGE CENTRAL JUSTICE CENTER 700 CIVIC CENTER DRIVE WEST POST OFFICE BOX 22024 SANTA ANA, CA 92702-2024

In the Matter of the Application of

---

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) M -

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 Form: L-410.2 [Rev. July 15, 2011]

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

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

SUPERIOR COURT OF CALIFORNIA, COUNTY OF ORANGE CENTRAL JUSTICE CENTER 700 CIVIC CENTER DRIVE WEST POST OFFICE BOX 22024 SANTA ANA, CA 92702-2024 IN THE MATTER OF THE APPLICATION OF

---

Petitioner's full name - First, Middle, Last

CASE NUMBER: PROOF OF SERVICE
M -
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 Form: L-0801 [Rev. March 24, 2011] and 4852.06

Name: Case Number: M-

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:

ORANGE COUNTY DISTRICT ATTORNEY
401 CIVIC CENTER DRIVE WEST
SANTA ANA, CA 92701

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 Form: L-0801 [Rev. March 24, 2011] and 4852.06