Second Most Recent Felony Conviction
On or about
, I was convicted of the crime of
,
Month Day, Year
Indicate crime and Penal Code Section
in the county of
, California. My sentence for this offense was:
[
]
Check appropriate box
Commitment to state prison or other state institution at
;
Name of institution or city where located
Probation with suspended sentence to state prison or other state institution;
Probation, after the sentencing proceedings were suspended.
Thereafter, on or about
, I was;
Date released from custody
[
]
Check appropriate box
Discharged from state prison or other state institution after completing my sentence;
Released on parole, from which I was finally discharged
;
on
Discharge date
Released from custody on probation after serving a jail sentence;
As a condition of my probation, I was released from custody after serving time in jail, and successfully
completed my probation on
, and obtained relief under Penal Code
Date probation ended
section 1203.4 on
.
Date 1203.4 granted by the Court
Third Most Recent Felony Conviction
On or about
, I was convicted of the crime of
,
Month Day, Year
Indicate crime and Penal Code Section
in the county of
, California. My sentence for this offense was:
[
]
Check appropriate box
Commitment to state prison or other state institution at
;
Name of institution or city where located
Probation with suspended sentence to state prison or other state institution;
Probation, after the sentencing proceedings were suspended.
Thereafter, on or about
, I was;
Date released from custody
[
]
Check appropriate box
Discharged from state prison or other state institution after completing my sentence;
Released on parole, from which I was finally discharged
;
on
Discharge date
Released from custody on probation after serving a jail sentence;
As a condition of my probation, I was released from custody after serving time in jail, and successfully
completed my probation on
, and obtained relief under Penal Code
Date probation ended
section 1203.4 on
.
Date 1203.4 granted by the Court
FORM 1 (Revised 1/21/98)
This form was prepared by the Investigations Division of the Board of Prison Terms pursuant to Penal Code Section 4852.18.