Mendocino — MTR-560

Source: https://www.mendocino.courts.ca.gov/system/files/forms-and-filings/mtr-560.pdf

SUPERIOR COURT OF CALIFORNIA, COUNTY OF MENDOCINO DECLARATION AND REQUEST FOR RECONSIDERATION OF CLERK DETERMINATION

NAME FOR COURT USE ONLY

ADDRESS

CITY STATE ZIP CODE

DATE OF BIRTH DRIVER LICENSE NUMBER

CASE OR CITATION NUMBER

This form must be completed and may only be submitted once to the Court. All supporting documentation must be attached. THE JUDGE’S DECISION WILL BE FINAL and will be mailed to you.

Previously, the clerk denied my request for relief through the MyCitations Ability to Pay program:

I request judicial review and reconsideration of the prior decision, based on additional information and supporting documentation I now provide to the court. (please attach additional pages if needed)

I declare under penalty of perjury that the foregoing is true and correct.

Date Defendant’s Signature

MTR-560 (rev 0924)