Mariposa — Civil Assessment Petition and Order

Source: https://www.mariposa.courts.ca.gov/system/files/civil-assessment-petition-and-order.pdf

Superior Court of the State of California

County of Mariposa

Collections Division

CIVIL ASSESSMENT PETITION AND ORDER

Defendant’s Request and Declaration to Vacate Civil Assessment

Defendant’s Name: Case Number: Total Due: $___________ IN ORDER TO REQUEST THAT CIVIL ASSESSMENT BE VACATED, YOU MUST: 1. Complete this petition thoroughly. 2. Attach written proof for the reason(s) why civil assessment should be vacated. 3. Submit payment in the amount of the original fine. Payment may be made in the form of check, cashier’s check, Money order, debit card, credit card or cash.

IMPORTANT: WRITTEN proof of any of the following MUST be attached and cover the time period in question.

I request that the court vacate the civil assessment in the above case, on the following grounds:

HOSPITALIZED OVERSEAS MILITARY DUTY INCARCERATED OTHER

The following is an explanation of my failure to pay:

I declare under penalty of perjury that the foregoing statement is true and correct to the best of my knowledge and that written proof is attached to this form.

Executed at on (CITY AND STATE) (DATE) Mailing address:

Telephone: Signature: (DEFENDANT)

ORDER/DECISION ON PETITION (COURT USE ONLY)

The Court having read and considered the Petition regarding vacating the Civil Assessment pursuant to PC 1214.1(B), hereby makes the following order:

Petition to vacate is: Denied Granted

DATE

(JUDICIAL OFFICER)

CIVIL ASSESSMENT PETITION AND ORDER Page 1 of 1
Defendant’s Request and Declaration to Vacate Civil Assessment

Local Form for Optional Use Mariposa Superior Court COL-003 [New November 2012]