Santa Barbara — SC-8021

Source: https://www.santabarbara.courts.ca.gov/system/files/sc8021.pdf

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SUPERIOR COURT OF CALIFORNIA, COUNTY OF SANTA BARBARA FOR COURT USE ONLY

Santa Barbara Division Santa Maria Division Lompoc Division
118 East Figueroa St. 312 East Cook St. Bldg. E 115 Civic Center Plaza

Santa Barbara, CA 93101 Santa Maria, CA 93454 Lompoc, CA 93436 (805) 568-3959 (805) 346-7550 (805) 737-7789

PLAINTIFF: People of the State of California

DEFENDANT:

FINANCIAL QUALIFICATION FOR WAIVER TO POST BAIL CITATION NUMBER:
TRAFFIC - CONFIDENTIAL

If you are receiving public benefits, are a low-income person, or do not have enough income to pay for household’s basic needs and your bail, you may use this form to ask the court to waive the posting of your bail.

1. Why are you asking the court to allow you to waive the posting of your bail?
I receive (check all that apply): Medi-Cal Food Stamps SSI/SSP General Assistance
IHSS (In-Home Supportive Services CalWORKS

If you checked any of the boxes above, stop here. Please sign and date the bottom of this form. If
not, proceed to #2

2. Are you a dependant on anyone else’s tax return (e.g., your parents)? Yes No

3. If the answer to #2 is yes, does that person refuse to pay for your infraction? Yes No

4. Your Household’s income
Source Amount
a. Gross monthly income (before deductions) $

b. List the source and amount of any other income you receive $
each month, including: spousal/child support, retirement, social $
security, disability, unemployment, veterans payments, dividends, $
interest, trust income, annuities, or other income. $

TOTAL MONTHLY INCOME: $ 0

5. Household Members
Name Age Relationship
a)
b)
c)
d)

You are signing your request under penalty of perjury. Please answer truthfully and accurately. The court may ask you for information or evidence. You may be ordered to go to court to answer questions about your ability to pay court obligations.

I declare under penalty of perjury that the information I have provided on this form is true and correct.

Date: SIGN SIGNATURE

SC-8021 [New January 1, 2016] FINANCIAL QUALIFICATION FOR WAIVER TO POST BAIL - CONFIDENTIAL