Amnesty Eligibility Declaration Form - 2015 - Superior Court Of California, County Of Santa Barbara Page 2
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1
2PLEASE NOTE THE FOLLOWING:
Are you eligible for the 50% amnesty reduction?
If, after this form is submitted, the court/county/collecting entity discovers you are not eligible for amnesty because you
have 1 or more outstanding warrants or owe victim restitution in this county, you shall be notified within 5 business days
that your form is being suspended. You will then have 20 business days to bring written proof to the
court/county/collecting entity that the outstanding warrant(s) and/or victim restitution issues have been addressed. On the
21st business day, or earlier if the information you provide does not demonstrate you are eligible for amnesty, the
court/county/collecting entity will retroactively cancel the amnesty program, restore previously reduced court-ordered
amounts, and credit any paid amounts toward your revised outstanding debt. The court/county/collecting entity will send
you notice of this action to the address indicated on this document.
Are you eligible for the 80% amnesty reduction?
If, after this form is submitted, the court/county/collecting entity discovers you are not eligible for the 80 percent reduction
in bail/fines/fees because you are not receiving public assistance as listed or because your household income is not at or
below 125 percent of the federal poverty rate, you shall be notified within 5 business days that your amnesty discount will
be revised. You will then have 20 business days to bring written proof to the court/county/collecting entity that you do
receive the specified public assistance or that your income is not at or below 125 percent of the federal poverty rate for
your household. On the 21st business day, or earlier if the information you provide does not demonstrate that you are
eligible for the 80 percent discount, the court/county/collecting entity will determine whether to revise the discount, if you
are eligible, to 50 percent of the amount owed for court-ordered debt or impose the full amount as discussed above and
credit any paid amounts toward your revised outstanding debt. The court/county/collecting entity will send you notice of
this action to the address indicated on this document.
FOR USE BY COURT ONLY
Citation/Fine Due Date:
Total Outstanding Balance:
$
Citation Number:
Amnesty Payment Due:
$
The Superior Court of California, County of Santa Barbara (or designated agent) has verbally verified case eligibility for
the amnesty program and has determined the following:
Eligible for:
50% Reduction
Full Payment
80% Reduction
Payment Plan
Driver’s License Reinstatement
Not Eligible for (check all that apply):
50% Reduction
80% Reduction
Driver’s License Reinstatement
Certified by: ________________________________________
Date: ______________________
Page 2
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