Statewide Traffic Tickets/infractions Amnesty Program Application Form September 2015 Page 2
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2Statewide Traffic Tickets/Infractions Amnesty Program Application Form
Completed form must be submitted starting October 1, 2015 and on or before March 31, 2017 to Mono County Superior Court
PLEASE NOTE: Application process can take up to 3-4 weeks
Signature__________________________________
Date ____________________
Your Name __________________________________
(please Print)
PLEASE READ THE FOLLOWING (
):
be sure to include this page when you submit the application form
Are you eligible for the 50% amnesty reduction?
If, after this form is submitted, the Court 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 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 will retroactively cancel the amnesty program, restore previously reduced court-
ordered amounts, and credit any paid amounts toward your revised outstanding debt. The Court will send
you notice of this action to the address you provided on this form.
Are you eligible for the 80% amnesty reduction?
If, after this form is submitted, the Court 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 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 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 will send you notice of this action to the address you provided on this form.
FOR USE ONLY BY MONO COUNTY SUPERIOR COURT STAFF
Appearance/Payment date: ________________________ Total outstanding balance: _______________
Citation number: _______________________________ Amnesty payment due: ___________________
The Superior Court of Mono County has verified case eligibility for the amnesty program and has determined
the following:
Eligible for (check all that apply):
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 Mono Superior Court Clerk: ___________________
To submit this form (be sure to include both pages) you can come to the Mammoth Lakes Courthouse at 100 Thompsons Way, Mammoth Lakes, Ca. or
mail the form to the Mono County Superior Court, PO Box 1037, Mammoth Lakes, Ca., 93546. No faxed or emailed copies will be accepted.
This form must be received by the Court on or before March 31, 2017
Page 2 of 2
Rev. 9/25/2015
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