Madera — Notice of Filing of Petition for Certificate of Rehabilitation and Pardon (MAD-CRM-009)

Source: https://www.madera.courts.ca.gov/system/files/forms-and-filings/mad-crm-009-notice-filing-petition-certificate-rehabilitation-and-pardon-pursuant-penal-code.pdf

MAD-CRM-009 IN THE SUPERIOR COURT OF THE STATE OF CALIFORNIA IN AND FOR THE COUNTY OF MADERA

FOR COURT USE ONLY

In the Matter of the Application of

Type Applicant’s Full Name – First, Middle, Last, and Suffix

Date of Birth:

CII Number:

Criminal Case Number:
List all applicable Criminal Numbers

NOTICE OF FILING OF PETITION FOR CERTIFICATE OF
REHABILITATION PARDON
Pursuant to Penal Code §§4852.01, 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 ;
2nd most recent felony in county of conviction, if applicable

District Attorney, County of ;
3rd 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 for petition for Certificate of Rehabilitation and Pardon The undersigned has filed a petition in the above-entitled court or courts for a Certificate of

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

Code of the State of California, and that the said petition has, by said court, been set for hearing on

the day of , 20 , at the hour of .m.of said day, Day of Hearing Month, Year Time of hearing Or as soon as the matter can be heard, in its courtroom Dept. at the courthouse in the city of Department , County of , State of California. City where hearing will be held

SIGN

Applicant’s Signature Month, Day, Year

Applicant’s Street Address

Applicant’s City, State and ZIP Code

Form Adopted for Optional Use NOTICE OF FILING OF PETITION FOR CERTIFICATE OF Page １ of 4 Madera Superior Court Local Form REHABILITATION AND PARDONMAD-CRM-009 [Rev. 04/15/2020] Pursuant to Penal Code §§4852.01, 4852.06

MAD-CRM-009 AFFIDAVIT OF SERVICE BY MAIL

STATE OF CALIFORNIA

City of , County of I, , being first duly sworn, deposes and says:

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

proceedings. I am a resident of the County of , State of California. County of Residence My residence business address is: Street Address

City, State and ZIP Code

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

Full Name-First Middle and Suffix Street Address County

Full Name-First Middle and Suffix Street Address County

Full Name-First Middle and Suffix Street Address County

Full Name-First Middle and Suffix 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 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

SIGN

Full Name of Notary Public – TYPED or PRINTED Notary Public - Signature

In and for the City of County of , California.

Form Adopted for Optional Use NOTICE OF FILING OF PETITION FOR CERTIFICATE OF Page ２ of 4 Madera Superior Court Local Form REHABILITATION AND PARDONMAD-CRM-009 [Rev. 04/15/2020] Pursuant to Penal Code §§4852.01, 4852.06

MAD-CRM-009

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

SIGN

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

SIGN

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

SIGN

Full Name of District Attorney – 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

SIGN

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

SIGN

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

SIGN

Full Name of District Attorney staff – TYPED OR PRINTED District Attorney staff – SIGNATURE

County District Attorney Month Day, Year

Form Adopted for Optional Use NOTICE OF FILING OF PETITION FOR CERTIFICATE OF Page ３ of 4 Madera Superior Court Local Form REHABILITATION AND PARDONMAD-CRM-009 [Rev. 04/15/2020] Pursuant to Penal Code §§4852.01, 4852.06

MAD-CRM-009

INSTRUCTIONS

1. After completing this Notice of Filing for Certificate of Rehabilitation and Pardon, Penal Code section 4852.07 requires that you 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; the District Attorney of each 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 these individuals at least thirty days prior to the date set for your hearing. (Pen. Code, § 4852.07.) You may do so by using one or both of the following forms:

Affidavit of Service by Mail (Page 2 of this document) – If you intend to have a Notary Public mail a copy of the Notice of filing for Certificate of Rehabilitation and Pardon, 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 (Page 3 of this document) – If you intend to hand-deliver a copy, you may do so by using 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 each individual, personally or by mail, file the 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, with the Superior Court in the county in which you reside.

Form Adopted for Optional Use NOTICE OF FILING OF PETITION FOR CERTIFICATE OF Page ４ of 4 Madera Superior Court Local Form REHABILITATION AND PARDONMAD-CRM-009 [Rev. 04/15/2020] Pursuant to Penal Code §§4852.01, 4852.06