Mendocino — MCR-220

Source: https://www.mendocino.courts.ca.gov/system/files/forms-and-filings/mcr-220.pdf

SUPERIOR COURT OF CALIFORNIA, COUNTY OF MENDOCINO

DECLARATION AND REQUEST FOR POSTPONEMENT OF JAIL SURRENDER DATE

NAME FOR COURT USE ONLY

ADDRESS

CITY STATE ZIP CODE

DATE OF BIRTH PHONE NUMBER

CASE NUMBER(S)

I was sentenced to serve a term of incarceration in the Mendocino County Jail and was ordered to appear

for surrender on / / . I understand that the court may, in its discretion, postpone my

jail surrender date if I provide good cause for such postponement. I request that my surrender date by

postponed to / / for the following reason(s):

I understand that, if granted, this request only changes my jail surrender date and that all other terms and conditions of my sentence remain in effect, including all due dates for other terms in my sentence. I understand that if I fail to appear for surrender at the jail when required to do so by the court, I may be charged with additional crimes.

I declare under penalty of perjury under the laws of the State of California that the information provided in this form is true and correct.

DATE: _______________________ Defendant’s Signature

MCR-220 (rev 0325) DECLARATION TO REQUEST POSTPONEMENT OF JAIL SURRENDER DATE