Kern — KRN SUP CRT 1121

Source: https://www.kern.courts.ca.gov/system/files/general/krn-sup-crt-1121-civil-assessment-petition-order-rev-82022.pdf

SUPERIOR COURT OF CALIFORNIA COUNTY OF KERN

CIVIL ASSESSMENT PETITION AND ORDER

Defendant’s Request and Declaration to Vacate Civil Assessment Imposed Pursuant to (PC 1214.1)

Defendant’s Name: Case Number:

TO REQUEST THAT A CIVIL ASSESSMENT BE VACATED:

1. Complete this petition thoroughly.
2. Attach sufficient documentation for the reason(s) why civil assessment should be vacated.

I request that the court vacate the civil assessment in the above case for my: FTA FTP IMPORTANT: Sufficient documentation of any of the following MUST be attached and cover the time period in question.

HOSPITALIZED INCARCERATION ACTIVE MILITARY DUTY DEATH OTHER The following is an explanation of my failure to appear/pay. (Please print)

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)

Address:

Telephone: Email: Signature: (DEFENDANT)

ORDER RE: CIVIL ASSESSMENT (COURT USE ONLY)

The court having read and considered the Petition regarding vacating the Civil Assessment imposed pursuant to PC 1214.1, hereby makes the following order: Petition to vacate is: Denied Granted Reduced

Date:

(JUDICIAL OFFICER)

Authorized Designee: Date:

KRN SUP CRT 1121 (OPTIONAL FORM) Civil Assessment Petition and Order (Rev 08/2022)