Form Sc-3038 - Decalration And Application By Defendant - County Of Santa Barbara
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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:
MAILING ADDRESS:
CITY AND ZIP CODE:
BRANCH NAME:
PLAINTIFF:
People of the State of California
DEFENDANT:
____________________________________________________________
PRINT OR TYPE DEFENDANTS NAME
CASE NUMBER:
DECLARATION AND APPLICATION BY DEFENDANT
PENAL CODE § 1210.1(d)
1.
My date of birth is ________________________________. My driver’s license number is ______________________________.
2.
On the date of __________________________________________, I was convicted of the offense(s) of violation of
section(s) ______________________________________________________________________________________________.
3.
I was placed on probation, and I have fulfilled all the conditions of probation for the entire time required. All fines/fees to the Court
and Provider are paid in full.
4.
I am not now charged with, serving a sentence for, or on probation for any offense. Since being 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 1210.1(d) of the Penal Code.
6.
I understand that if the court finds that I have successfully completed drug treatment and complied with the conditions of probation,
and that the conviction is set aside and the action is dismissed, and that except as noted below, both the arrest and the conviction
shall be deemed never to have occurred. The requested dismissal: (a) does not allow me to own, possess, or have in my custody
or control any firearm capable of being concealed upon my person or prevent my conviction under section 12021, (b) will not
prevent this conviction from being pleaded 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 a position as a
peace officer as defined by Section 830, for licensure by any state or local agency, or for contracting with the California State
Lottery, or for purposes of serving on a jury.
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
CII and DMV cleared on ________________________________ by _____________________________________
Date
Deputy Clerk
ORDER
The declaration and application by defendant is
Granted Pursuant to Penal Code section 1210.1(d), it is so ordered that the conviction be set aside, a plea of not guilty be
entered, and the indictment, information, or complaint dismissed.
Denied ____________________________________________________________________________________________
Dated: __________________________________
__________________________________________________
Judge of the Superior Court
SC-3038 [Rev. Oct. 18, 2002]
PC 1210.1(d)
DECLARATION AND APPLICATION BY DEFENDANT
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