Form Sc-3004 - Declaration And Application For Change Of Plea And Request For Dismissal - County Of Santa Barbara
Download a blank fillable Form Sc-3004 - Declaration And Application For Change Of Plea And Request For Dismissal - County Of Santa Barbara in PDF format just by clicking the "DOWNLOAD PDF" button.
Open the file in any PDF-viewing software. Adobe Reader or any alternative for Windows or MacOS are required to access and complete fillable content.
Complete Form Sc-3004 - Declaration And Application For Change Of Plea And Request For Dismissal - County Of Santa Barbara with your personal data - all interactive fields are highlighted in places where you should type, access drop-down lists or select multiple-choice options.
Some fillable PDF-files have the option of saving the completed form that contains your own data for later use or sending it out straight away.
ADVERTISEMENT
1Choose a location
FOR COURT USE ONLY
ATTORNEY OR PARTY WITHOUT ATTORNEY (NAME AND ADDRESS):
TELEPHONE NO.:
ATTORNEY FOR (NAME):
SUPERIOR COURT OF CALIFORNIA, COUNTY OF SANTA BARBARA
STREET ADDRESS:
CITY AND ZIP CODE:
BRANCH NAME:
People of the State of California
PLAINTIFF:
DEFENDANT:
____________________________________________________________
PRINT OR TYPE DEFENDANTS NAME
Declaration and Application for Change of Plea and Request
CASE NUMBER:
for Dismissal (PC § 1203.4/1203.4a)
1.
My date of birth is __________________________________. My driver’s license number is __________________________________.
2.
On the date of __________________________________________, I was convicted of the misdemeanor/infraction offense(s) of
violation of section(s)
______________________________________________________________________________________________________.
3.
I was: (check one)
(1203.4) placed on probation, and I have fulfilled all the conditions of probation for the entire time required.
(1203.4a) sentenced more than one year ago, without probation, and I have fully complied with the sentence.
4.
I am not now charged with, serving a sentence for, or on probation for any offense. Since being sentenced or placed on probation in this
case, I have lived an honest life, have conformed to and obeyed the laws of the land, and have not been convicted, arrested, or given a
citation (ticket) except
_____________________________________________________________________________________________________________.
5.
I request that the conviction be set aside, that a plea of not guilty be entered, and that the Court dismiss this action pursuant to the
provisions of section 1203.4/1203.4a of the Penal Code.
6.
I understand that the requested dismissal: (a) will not affect any revocation or suspension of my driving privilege, (b) will not prevent this
conviction from being pled to and proved in any subsequent prosecution, and (c) will not relieve me of the obligation to disclose the
conviction in response to a direct question in any questionnaire or application for public office, for licensure by any state or local agency, or
for contracting with the California State Lottery.
7.
Fee Waiver request – If you cannot afford to pay court fees and costs, you may not have to pay them. If you are receiving public benefits,
are a low-income person, or do not have enough income to pay for your household’s basic needs and the court fees, you may ask the
court to waive all or part of your court fees. To make a request to the court to waive your fees in superior court, complete the Request to
Waive Court Fees (form FW-001) and attach to this form.
I declare under penalty of perjury under the laws of the State of California that the foregoing is true and correct.
Signed on _____________________________________________ at _______________________________________________, California.
Date
Place
Signature of Defendant
Print or Type Defendant’s Name
Street Address
City
State
Zip Code
DO NOT WRITE BELOW THIS LINE - FOR COURT USE ONLY
YOU MUST APPEAR IN COURT ON: ___________________________________ TIME: ____________ DEPT: ____________
District Attorney notified on ________________________ by ______________________________, Deputy
CII and DMV processed on ________________________ by ______________________________, Deputy
ORDER
The declaration and application by defendant is
Granted Pursuant to Penal Code section 1203.4/1203.4a, it is so ordered that the conviction be set aside, a plea of not guilty be
entered, and the complaint dismissed upon payment of any fee imposed by the court on this order.
Pay fee in the amount of
$50.00 (court costs) and
$7.00 (county costs) to the Court by ________________________.
Pay fee in the amount of $_________ (court costs) and $ _________ (county costs) to the Court by ________________________.
No fee imposed.
Denied ___________________________________________________________________________________________________
Dated: _______________________
_____________________________________________________
Judge of the Superior Court
SC-3004 [Rev. June 2015]
PC 1203.4/1203.4a
Declaration/Application for Change of Plea/Dismissal
Print Form
Clear Form
ADVERTISEMENT
0 votes
Related Articles
Related forms
Form Sc Sch.tc-57a - Application For Parental Refundable Credit - South Carolina Department Of Revenue
Financial
Form Sc Sch.tc-57a - Application For Parental Refundable Credit July 1, 2017 - June 30, 2018
Financial
Related Categories
Parent category: Legal