Amador — CRIM-502.2

Source: https://amador.courts.ca.gov/system/files/crim-5022_ntc_petitionforcertificateofrehabilitation.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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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 (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 Amador.

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 CRIM-502.2 (06/12/2019)