El Dorado — Notice of Petition for Certificate of Rehabilitation and Pardon

Source: https://www.eldorado.courts.ca.gov/system/files/notice-petition-certificate-rehabilitation-and-pardon.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

Court use only

Type Applicant’s Full Name - First Middle Last and Suffix, if applicable

Date of Birth Month Day, Year CII Number

Criminal Case Number(s) List applicable Criminal Case Number(s)

NOTICE OF FILING OF PETITION FOR CERTIFICATE OF REHABILITATION AND PARDON Pursuant to Penal Code Sections 4852.01 and 4852.06

To the Governor of the State of California:

District Attorney, County of ; County of Residence

District Attorney, County of ; Most recent felony in county of conviction, if different from County of Residence

District Attorney, County of ; 2 nd most recent felony in county of conviction, if applicable

District Attorney, County of ; 3 rd most recent felony in county of conviction, if applicable

You and Each of You Will Please Take Notice That On the day of ; Date you filed your Petition for Certificate of Rehabilitation and Pardon

the undersigned has filed a petition in the above-mentioned court(s) for a 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, and that said petition has, by said court, been set for a hearing on the day of Day of hearing

to commence at a.m. p.m., of said day, or as soon
Month, Year Time of hearing

as the matter can be heard, in its courtroom, department at the courthouse Department

in the city of ,county of state of California. City where hearing will be held County where hearing will be held

Applicant's Signature Month Day, Year

Applicant's Street Address

Applicant's City, State ZIP Code

FORM 2 (Revised 3/25/04) This form was prepared by the Investigations Division of the Board of Parole Hearings pursuant to Penal Code Section 4852.18.

AFFIDAVIT OF SERVICE BY MAIL

STATE OF CALIFORNIA

City of , County of

I, being first duly sworn, deposes, and says: Full Name - First Middle Last and Suffix, if applicable

I am a citizen of the United States, am over the age of 18 years, and am not a party to the above-entitled

proceeding. I am a resident of the County of , State of California. County of Residence

My residence business address is Street Address

City, State ZIP Code

On the day of , I served the attached Notice to each person listed below Day of the Month Month, Year

Full Name - First Middle Last and Suffix, if applicable Street Address County

Full Name - First Middle Last and Suffix, if applicable Street Address County

Full Name - First Middle Last and Suffix, if applicable Street Address County

Full Name - First Middle Last and Suffix, if applicable Street Address County

by placing a copy of this Notice in a sealed envelope and mailing it first class, postage pre-paid to each

person as listed above. There is a delivery service by United States mail at each of the places so

addressed, or there is a regular communication by mail between the place of mailing and each of the

places so addressed.

Subscribed and sworn to before me this day of . Day of the Month Month, Year

Full Name of Notary Public - TYPED or PRINTED Notary Public - SIGNATURE

In and for the City of , County of , California.

FORM 2A (Revised 12/12/18) This form was prepared by the Investigations Division of the Board of Parole Hearings pursuant to Penal Code Section 4852.18.

NOTICE OF SERVICE IN PERSON

Receipt of copy of this Notice is hereby admitted this day of . Day of the month Month, Year

Governor's Office
State Capitol
Legal Affairs Division

Full Name of Governor's staff - TYPED or PRINTED Governor's staff - SIGNATURE

Governor's staff - TITLE Month Day, Year

Receipt of copy of this Notice is hereby admitted this day of . Day of the month Month, Year

Full Name of District Attorney staff - TYPED or PRINTED District Attorney staff - SIGNATURE

County District Attorney Month Day, Year

Receipt of copy of this Notice is hereby admitted this day of . Day of the month Month, Year

Full Name of District Attorney staff - TYPED or PRINTED District Attorney staff - SIGNATURE

County District Attorney Month Day, Year

Receipt of copy of this Notice is hereby admitted this day of . Day of the month Month, Year

Full Name of District Attorney staff - TYPED or PRINTED District Attorney staff - SIGNATURE

County District Attorney Month Day, Year

Receipt of copy of this Notice is hereby admitted this day of . Day of the month Month, Year

Full Name of District Attorney staff - TYPED or PRINTED District Attorney staff - SIGNATURE

County District Attorney Month Day, Year

FORM 2B (Revised 3/25/04) This form was prepared by the Investigations Division of the Board of Parole Hearings pursuant to Penal Code Section 4852.18.

FORM 2 INSTRUCTIONS

1. After completing this Notice of Filing for Certificate of Rehabilitation and Pardon, make enough copies to distribute one (1) copy to:

   the Governor of California; the District Attorney in your county of residence where you filed your Petition for Certificate of Rehabilitation and Pardon, and;

each District Attorney of the county in which you were convicted of a felony.

2. This Notice of Filing for Certificate of Rehabilitation and Pardon must be served to all of the aforementioned individuals at least thirty (30) days prior to the date set for your hearing. You may do so by utilizing one or both of the following forms, in any combination necessary, as long as all of the aforementioned individuals have been served.

   Affidavit of Service by Mail (Form 2A) - If you intend to have a Notary Public mail a copy of the Notice of Filing for Certificate of Rehabilitation and Pardon to each of the aforementioned individuals, you may do so by having the Notary Public complete and sign the Affidavit of Service by Mail. Mailing procedures are outlined in the Affidavit.

   Notice of Service in Person (Form 2B) - If you intend to hand-deliver a copy to each of the aforementioned individuals, you may do so by utilizing this form and having each individual sign in the appropriate space indicating that a copy of the Notice of Filing for Certificate of Rehabilitation and Pardon was received.

3. After you have served all the aforementioned individuals, personally or by mail, file this completed Notice of Filing for Certificate of Rehabilitation and Pardon and the Affidavit of Service by Mail or Notice of Service in Person, or both, as the case may be, with the Superior Court in the county in which you reside.