Fillable AMNESTY PROGRAM Statewide Traffic Tickets/Infractions Superior Court of (The Superior Court of California, County of Santa Clara)

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AMNESTY PROGRAM Statewide Traffic Tickets/Infractions Superior Court of (The Superior Court of California, County of Santa Clara)

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AMNESTY PROGRAM
Statewide Traffic Tickets/Infractions
Superior Court of California, County of Santa Clara
October 1, 2015 to March 31, 2017
Date: Driver’s License Number:
Name: E-mail:
Current Address: Social Security Number:
Citation/Court Case Number: Date of Birth:
Contact Number(s): Home Mobile: Work:
1. I am seeking (select one or both):
Reduction in eligible unpaid bail/fines/fees
Driver’s license reinstatement
2. In order to be eligible for a reduction in my unpaid bail/fines/fees, I declare all of the following are true:
• I do not owe restitution to a victim within the county where the violation occurred.
• I do not have any outstanding misdemeanor or felony warrants in the county where the violation occurred.
• I made no payments to the court, county, or collecting agency for the eligible violation after September 30, 2015.
3. In order to be eligible for the restoration of my driver’s license only, I declare one or both of the following
is true:
a. I have appeared and satisfied all my court-ordered obligations in this county.
b. I am making payments to a comprehensive collections program on eligible violations and I am current
on my installment payment plan.
4. By signing below, I confirm that I understand each of the following:
• I must pay the reduced balance owed in full at this time or comply with terms of the approved payment plan.
• I will pay an amnesty program fee of $50 in order to participate.
• If I stop making payments on my amnesty case, the remaining balance may be referred to the Franchise
Tax Board or a third party for collection.
• If my case is determined not to be eligible at a later time, I may have to pay the adjusted or full amount.
(See reverse for details.)
Complete Either Section A or B
A. I declare under penalty of perjury under the laws of the State of California that the following is true and correct to the best
of my knowledge and belief:
I receive the following public assistance (check all that apply):
Supplemental Security Income/SSI
County relief, general relief, or general assistance
State Supplementary Payment/SSP
CalWORKs
Medi-Cal
Cash Assistance Program for Immigrants (CAPI)
In-Home Supportive Services (IHSS)
Tribal Temporary Assistance for Needy Families (TANF)
CalFresh (Supplemental Nutrition Assistance Program)
B. I declare under penalty of perjury under the laws of the State of California that the following is true and correct to the
best of my knowledge and belief:
My total gross monthly household income is _______________________________________________________
And a total of _____________________ dependents live in the household.
I understand that if I provide incorrect or inaccurate information, the debt reduction amount may change and I
will be responsible for payment of the adjusted or full amount.
Signature:
Date:
TR-7003 REV 2/4/16 (V.C. § 42008.8) Page 1 of 2
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AMNESTY PROGRAM
Statewide Traffic Tickets/Infractions
Superior Court of California, County of Santa Clara
October 1, 2015 to March 31, 2017
A
re you eligible for the 50% amnesty reduction?
After you submit this amnesty request, if the court, county, or collecting agency discovers that you are not eligible
for amnesty because you have 1 or more outstanding warrants or owe victim restitution in this county, you will
receive written notice within 10 business days that your request is being suspended. You will then have 20 business
days from the date on the notice to bring to the court, county, or collecting agency written proof that the outstanding
warrant(s) and/or victim restitution issues have been fixed. If you do not respond to the notice, then on the 21st
business day after the date of the notice, or earlier if your proof does not show that you are eligible for amnesty,
your amnesty request will be retroactively cancelled and your previously reduced court-ordered amounts will be
restored, and any amounts you paid will be credited toward your revised outstanding debt. You will receive the
notice(s) described above at the address you provided on page one of this request.
Are you eligible for the 80% amnesty reduction?
After you submit this amnesty request, if the court, county, or collecting agency discovers that you are not eligible
for the 80 percent reduction in bail, fines, and/or fees because you do not receive public assistance as listed or
because your household income is too high, you will receive written notice within 10 business days that your
amnesty discount will be revised. You will then have 20 business days from the date on the notice to bring to the
court, county, or collecting agency written proof that you do receive the specified public assistance or that your
income is at or below 125 percent of the federal poverty rate for your household. If your written proof shows that
you are eligible, your court-ordered amount will be revised to 20 percent of the amount owed. If you do not respond
to the notice, then on the 21st business day from the date on the notice, or earlier if your proof does not show that
you are eligible for the 80 percent discount, the agency will cancel the discount, and the full amount will be
imposed, and any amounts you paid will be credited toward your revised outstanding debt. You will receive the
notice(s) described above at the address you provided on page one of this request.
If you are eligible for either amnesty program:
A one-time $50.00 administrative fee is due with your first payment. And, if you choose installment payments, the
minimum payment amount is $25.00. Payment in full or the first installment payment must be received by the Court
no later than March 31, 2017. Your driver’s license will not be reinstated for 20 days if you pay by check.
FOR OFFICIAL USE ONLY
Court case number:
Total adjusted balance:
The Superior Court of California, County of Santa Clara has verified case eligibility for the amnesty program
and has determined the following:
Eligible for:
50% reduction
Outstanding warrant
80% reduction
Due date after Jan 1, 2013
Restitution owed
Payment received after Sep 30, 2015
Ineligible violations
Not current on payments in a
comprehensive debt collection
program (driver’s license
reinstatement only)
Certified by: ____________________
TR-7003 REV 2/4/16 (V.C. § 42008.8) Page 2 of 2
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AMNESTY PROGRAM Statewide Traffic TicketsInfractions Superior Court of (The Superior Court of California, County of Santa Clara)

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Completed 29 June 2021

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