Mendocino — MTR-500

Source: https://www.mendocino.courts.ca.gov/system/files/forms-and-filings/mtr-500.pdf

SUPERIOR COURT OF CALIFORNIA, COUNTY OF MENDOCINO DECLARATION AND REQUEST FOR FINE REDUCTION AND TRAFFIC VIOLATOR SCHOOL

NAME FOR COURT USE ONLY

ADDRESS

CITY STATE ZIP CODE

DATE OF BIRTH DRIVER LICENSE NUMBER

CASE OR CITATION NUMBER TVS ELIGIBLE YES NO

A judge will review and rule on your request for traffic school. You will be notified of the decision by mail.

I request a reduction in the amount of my fine. My violation(s) appear to be traffic school eligible on my notice from the court, therefore I also request that I be permitted to attend traffic school. I understand that, in addition to my fine, I must pay $54.00 to the court for traffic school and that the traffic school will also impose additional fees.

1. Public Benefits – Check any benefits listed below that you are receiving now. If you do not receive
   benefits, go to the next question.

   Medi-Cal CalFresh/WIC CalWorks CAPI SSI/SSP
   Low-Income Veterans Pension Tribal TANF Refugee Cash Assistance
   General Assistance IHSS Extended Foster Care
   Other need-based help (specify):

   Important! Attach a copy of any document that proves you are getting the benefits you checked.

2. Household Income (skip this section if you checked any public benefits in Item 1)

   Monthly income $ Number of people in household: Important! Attach a copy of any document(s) that proves the amount of gross-monthly income (before tax deductions) for your household.

3. Other requests:

Read and sign below.

I understand that I have the right to: an attorney (at my own cost); a court trial within 45 days from the

date of the entry of this plea; confront and cross-examine witnesses against me; present evidence on my own behalf and avoid self-incrimination. I hereby enter a plea of GUILTY or NO CONTEST, if one was not previously entered, and request that a judge grant my requests.

I declare under penalty of perjury under the laws of the State of California that the information I have

provided on this form is true and correct.

Date: Declarant signature

MTR-500 (rev 0124)