Free SC-3004 - California

Choose a location
ATTORNEY OR PARTY WITHOUT ATTORNEY (NAME AND ADDRESS): TELEPHONE NO.: FOR COURT USE ONLY

ATTORNEY FOR (NAME):

SUPERIOR COURT OF CALIFORNIA, COUNTY OF SANTA BARBARA
STREET ADDRESS: CITY AND ZIP CODE: BRANCH NAME: PLAINTIFF: DEFENDANT:

People of the State of California
____________________________________________________________ PRINT OR TYPE DEFENDANTS NAME

DECLARATION AND APPLICATION BY DEFENDANT PENAL CODE § 1203.4/1203.4a
1. 2. 3. 4.

CASE NUMBER:

My date of birth is ________________________________. My driver's license number is ______________________________. On the date of __________________________________________, I was convicted of the misdemeanor offense(s) of violation of section(s) ______________________________________________________________________________________________. I was: (check one) placed on probation, and I have fulfilled all the conditions of probation for the entire time required. sentenced more than one year ago, without probation, and I have fully complied with the sentence. 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 _______________________________________________________________________________________________________. 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. 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 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 licensure by any state or local agency, or for contracting with the California State Lottery.

5. 6.

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 Signature of Defendant Street Address City Place Print or Type Defendant's Name 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 cleared 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. Pay fee in the amount of $ ____________ by _____________________. No fee imposed.

Denied ____________________________________________________________________________________________ Dated: _______________________
SC-3004 [Rev. Aug. 20, 2003]

__________________________________________________ Judge of the Superior Court
PC 1203.4/1203.4a

DECLARATION AND APPLICATION BY DEFENDANT
Clear Fields

Print Form